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Identifying and addressing barriers for insulin use in patients with type-2 diabetes mellitus

Ibrahim El Bayoumy

Background: DM type-2 is characterized by gradual decrease in insulin sensitivity within the peripheral tissues and liver (insulin resistance), followed by gradual decline in β-cell function and insulin secretion. Thus, patients with poor glycemic control require the utilization of insulin therapy to realize the target of yank Diabetes Association, recommending HbA1c to be but 7% (≥8% despite of optimal doses of anti-diabetic drugs). Aim: This study aimed to guage and addressing the barriers to be used of insulin in type-2 DM patients, where their glycemic control is poor, i.e., HbA1c is ≥8% despite of optimal doses of anti-diabetic drugs. Research Design & Method: We surveyed 200 patients with type-2 diabetes mellitus, i.e., cross-sectional quantitative study; patients showed poor glycemic control HbA1c≥8%, already treated with one or more oral agents, who recently prescribed insulin to regulate their metabolic status. Data were obtained by patient’s interview employing a validated questionnaire. The place of the study was in DM clinic in Farwaniyah Primary Health Care Center in Kuwait. Result: Patients with type-2 diabetes failing to initiate the prescribed insulin therapy have reported misconception regarding fear of hypoglycemia in 49% of the entire sample, pain from injections in 68% and self-blame about need for insulin i.e., sense of failure in 61% of total sample of study. Other factors were addressed like sensation by getting more severity of the disease, weight gain fear and other negative self-perceptions and attitudinal barriers were studied. Conclusion: Reducing the negative influence of psychological insulin resistance (PIR) on treatment outcomes should be a clinical priority. Approaching and understanding the multifaceted and sophisticated nature of PIR and discussing the etiology of each patient’s PIR is that the first important step. The incorporation of well-validated clinical measures assessing these barriers, also as further research should be conducted on the impact of interventions to beat such barriers. Clinicians should prescribe simple insulin regimen to decrease their patients’ fear from dependency of insulin and therefore the use of recent insulin analogs and insulin pen services, may greatly reduce PIR by mitigating the fear of life style changes and side effects, also as social stigma related to using insulin during a vial and syringe.