Insulin Refusal in Iranian Patients with Poorly Controlled Type 2 Diabetes Mellitus
,
Abstract
To achieve tight glycemic control in diabetic patients, it may be necessary to introduce insulin therapy much earlier in the disease course. Poor glycemic control is a risk factor for the development of diabetic complications. Many patients require insulin therapy after several years of disease in order to maintain good glycemic control and prevent complications. But many patients do not receive insulin therapy in a timely manner because of a negative appraisal of this treatment. Understanding the cause of this negative attitudes is necessary for better evaluation to overcome for this problem. The purpose of this study was to evaluate the reasons for insulin refusal among patients with type 2 diabetes. This is a descriptive cross-sectional study from Yazd Diabetes Research Center. 400 patients with type 2 diabetes who had an HbA1c ≥8.0% despite optimal oral therapy were identified that participated in this study. Data were obtained by patient interview using validated questionnaires. This study showed that Insulin refusal was common. 77% of participant reported being unwilling to take insulin if prescribed. Fear of injection is an important cause for insulin refusal among patients. Insulin refusal is an important problem among our patients with type 2 diabetes mellitus. Findings of this study suggest that interventions aimed at increasing insulin use should focus on injection-related concerns, education and correction of misconceptions.
Wright A, Burden AC, Paisey RB, Cull CA, Holman RR, U.K. Prospective Diabetes Study Group. Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57). Diabetes Care,2002;25(2):330–6.
The DCCT Research Group .The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329(14):977-86.
The UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylurea or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352(9131):837-53.
ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G, Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B, Bompoint S, de Galan BE, Joshi R, Travert F. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358(24):2560-72.
Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, Golden SH: Meta-analysis. glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004;141(6):421-31.
Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, Landgraf R, Kleinebreil L, theInternational DAWN Advisory Panel . Resistance to insulin therapy among patients and provides: results of the cross-national Diabetes Attitudes,Wishes and Needs study. Diabetes Care 2005;28(11):2673–79.
Larkin ME, Capasso VA, Chen CL, Mahoney EK, Hazard B, Cagliero E, Nathan DM. Measuring psychological insulin resistance: barriers to insulin use.Diabetes Educ 2008;34(3):511–7.
Khan H, Lasker SS, Chowdhury TA. Prevalence and reasons for insulin refusal in Bangladeshi patients with poorly controlled Type 2 diabetes in East London. Diabetic Med 2008;25(9):1108–11.
Wong S, Lee J, Ko Y, Chong MF, Lam CK, Tang WE. Perceptions of insulin therapy amongst Asian patients with diabetes in Singapore. Diabetic Med 2011;28(2):206–11.
Afkhami- Ardekani M, Vahidi S, Vahidi A, Ahmadie MH. Epidemiological survey of type 2 diabetes in peopleover 30 years old in yazd province. Journal of Shahid sadoughi University of Medical Sciences and Health Services 2002;9(1):22-27.
Petrak F, Stridde E, Leverkus F, Crispin AA, Forst T, Pfu¨ tzner A. Development and validation of a new measure to evaluate psychological resistance to insulin treatment. Diabetes Care 2007;30(9):2199–04.
Skovlund SE, van der Ven N, Pouwer F, Snoek F. Appraisal of insulin treatment in Type 2 diabetes patients with and without previous experience of insulin therapy (abstract). Diabetes 2003;52:A419.
Zambanini A, Newson RB, Maisey M, Feher MD. Injection related anxiety in insulin-treated diabetes. Diabetes Res Clin Pract 1999;46(3):239–46.
Brod M, Kongs, JH, Lessard S, Christensen TL. Psychological insulin resistance: patient beliefs and implications for diabetes management. Qual Life Res 2009;18(1):23–32.
David GM. Overcoming patient barriers to initiating insulin therapy in type 2 diabetes mellitus. Clinical Cornerstone 2007;8(2):33–43.
Diglas J, Feinbock C, Winkler F, Egger T, Weitgasser R, Pieber T, Lytzen L, Irsigler K. Reduced pain perception with an automatic injection device for use with an insulin pen. Hormone Metab Res 1998;30:A10.
Kadiri A, Chraibi A, Marouan F, Ababou MR, el Guermai N, Wadjinny A, Kerfati A, Douiri M, Bensouda JD, Belkhadir J, Arvanitis Y. Comparison of NovoPen 3 and syringes ⁄ vials inthe acceptance of insulin therapy in NIDDM patients with secondary failure to oral hypoglycaemic agents. Diabetes Res Clin Pract 1998;41(1):15–23.
Hunt LM, Valenzuela MA, Pugh JA. NIDDM patients’ fears and hopes about insulin therapy. The basis of patient reluctance. Diabetes Care 1997;20(3):292–8.
Martha M, Funnell, MS, RN, CDE. Overcoming barriers to the initiation of insulin therapy. Clinical Diabetes 2007;25:36-8.
Shiu AT, Kwan J, Wong RY. Social stigma as a barrier to diabetes self-management: Implications for multilevel interventions. Journal of Clinical Nursing 2003;12(1):149-50.
Cappelleri JC, Gerber RA, Kourides IA, Gelfand RA. Development and factor analysis of a questionnaire to measure patient satisfaction with injected and inhaled insulin for type 1 diabetes. Diabetes Care 2000;23(12):1799–803.
Stotland NL. Overcoming psychological barriers in insulin therapy. Insulin 2006;1(1):38-45.
| Files | ||
| Issue | Vol 51, No 8 (2013) | |
| Section | Articles | |
| Keywords | ||
| Diabetes mellitus Insulin therapy Questionnaire | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
