Factors associated with adherence or nonadherence to insulin therapy among adults with type 2 diabetes mellitus: A scoping review

Skriver, Lea Kirstine Lewerenz; Nielsen, Malene Winther; Walther, Simone; Nørlev, Jannie Damsgaard; Hangaard, Stine

doi:10.1016/j.jdiacomp.2023.108596

Cited by 7 publications

(7 citation statements)

References 52 publications

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“…The present study showed that both depression and anxiety scores were higher in diabetic individuals who refused insulin treatment. Previous literature has reported that depression and fear negatively affect adherence to insulin therapy [17]. Another study reported emotional or psychological problems of patients as the reason for delaying insulin treatment [15].…”

Section: Discussionmentioning

confidence: 99%

Investigating the Relationship Between Insulin Treatment Refusal and Psychosocial Factors in Type 2 Diabetic Patients

Şahin,

Yakar,

Gömleksiz

et al. 2024

Eur J Ther

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Objective: Refusal of insulin therapy is an important barrier in the treatment of type 2 diabetes mellitus (T2DM). The current study aimed to investigate the effect of psychosocial status of diabetic patients on insulin treatment acceptance and refusal. Methods: This cross-sectional study was conducted with age and gender matched 80 diabetic patients who accepted insulin therapy and 80 diabetic patients who refused insulin therapy. Participants were interviewed face-to-face using a questionnaire consisting of five sections: socio-demographic, depression, anxiety, fear of self-injection and adherence to diabetes treatment. Results: There was no significant difference between the two groups in terms of age and gender. The beck depression scale score (p=0.002) and beck anxiety scale score (p<0.001) of the participants who refused insulin treatment were statistically significantly higher than the group who accepted the treatment. The injection fear scale score of the group who refused insulin treatment was statistically significantly higher than those who accepted insulin treatment (p<0.001). There was a significant negative correlation between injection fear score and treatment adherence scale score in both participants who accepted (r:-0.224; p:0.045) and refused insulin treatment (r:-0.309; p:0.005). Conclusion: The current study showed that depressive and anxiety moods of the individuals caused insulin therapy refusal. In addition, fear of injection was another factor causing insulin treatment refusal. Depression and fear of injection were also found to negatively affect adherence to treatment.

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Section: Discussionmentioning

confidence: 99%

Investigating the Relationship Between Insulin Treatment Refusal and Psychosocial Factors in Type 2 Diabetic Patients

Şahin,

Yakar,

Gömleksiz

et al. 2024

Eur J Ther

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“…Moreover, lower adherence has been observed in patients undergoing insulin treatment compared to those using oral medications. Possible factors associated with non-adherence include certain sociodemographic characteristics, forgetfulness, lack of knowledge or diabetes education, fear of potential side effects, lack of confidence in the treatment, and economic considerations (6).…”

Section: Lack Of Adherencementioning

confidence: 99%

“…Weight gain, documented in many studies involving patients on insulin treatment, is a limitation, especially for those who are overweight or obese. While initial weight gain is sometimes related to improved glycemic control and decreased glycosuria, particularly in patients with poor previous control (6,38).…”

Section: Weight Gainmentioning

confidence: 99%

“…It is now acknowledged that insulinization should begin with the addition of basal insulin to the patient's existing treatment and, if necessary, progress by gradually introducing prandial insulin. However, there are various barriers to insulin therapy, on the part of both patients and healthcare professionals, which unjustifiably delay the initiation of insulinization or influence patients' non-adherence to insulin treatment (6). Undoubtedly, the daily administration of one or more doses of insulin represents one of the most significant barriers to insulin treatment.…”

Section: Introductionmentioning

confidence: 99%

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Current barriers to initiating insulin therapy in individuals with type 2 diabetes

Galdón Sanz-Pastor,

Justel Enríquez,

Sánchez Bao

et al. 2024

Front. Endocrinol.

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Insulin is an essential drug in the treatment of diabetes, often necessary for managing hyperglycemia in type 2 diabetes mellitus (T2DM). It should be considered in cases of severe hyperglycemia requiring hospitalization, after the failure of other treatments, in advanced chronic kidney disease, liver cirrhosis, post-transplant diabetes, or during pregnancy. Moreover, in specific patient subgroups, early initiation of insulin is crucial for hyperglycemia control and prevention of chronic complications. Clinical guidelines recommend initiating insulin when other treatments fail, although there are barriers that may delay its initiation. The timing of initiation depends on individual patient characteristics. Typically, insulinization starts by adding basal insulin to the patient’s existing treatment and, if necessary, progresses by gradually introducing prandial insulin. Several barriers have been identified that hinder the initiation of insulin, including fear of hypoglycemia, lack of adherence, the need for glucose monitoring, the injection method of insulin administration, social rejection associated with the stigma of injections, weight gain, a sense of therapeutic failure at initiation, lack of experience among some healthcare professionals, and the delayed and reactive positioning of insulin in recent clinical guidelines. These barriers contribute, among other factors, to therapeutic inertia in initiating and intensifying insulin treatment and to patients’ non-adherence. In this context, the development of once-weekly insulin formulations could improve initial acceptance, adherence, treatment satisfaction, and consequently, the quality of life for patients. Currently, two once-weekly basal insulins, insulin icodec and basal insulin BIF, which are in different stages of clinical development, may help. Their longer half-life translates to lower variability and reduced risk of hypoglycemia. This review addresses the need for insulin in T2DM, its positioning in clinical guidelines under specific circumstances, the current barriers to initiating and intensifying insulin treatment, and the potential role of once-weekly insulin formulations as a potential solution to facilitate timely initiation of insulinization, which would reduce therapeutic inertia and achieve better early control in people with T2DM.

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“…Proper adherence helps maintain stable blood sugar levels, preventing complications associated with high or low glucose levels. Factors influencing adherence include the complexity of the insulin regimen, fear of injections, and lifestyle considerations [ 28 , 29 , 30 , 31 ]. Hence, non-invasive insulin therapy increases adherence to therapy [ 32 , 33 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

Unraveling Light-Activated Insulin Action in Regulating Blood Glucose: New Photoactivatable Insight as a Novel Modality in Diabetes Management

Nurkolis,

Kurniawan,

Wiyarta

et al. 2024

Molecules

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Diabetes, particularly type 2 diabetes (T2D), is the main component of metabolic syndrome. It is highly prevalent and has drastically increased with sedentary lifestyles, notably behaviors linked to ease of access and minimal physical activity. Central to this condition is insulin, which plays a pivotal role in regulating glucose levels in the body by aiding glucose uptake and storage in cells, and what happens to diabetes? In diabetes, there is a disruption and malfunction in insulin regulation. Despite numerous efforts, effectively addressing diabetes remains a challenge. This article explores the potential of photoactivatable drugs in diabetes treatment, with a focus on light-activated insulin. We discuss its advantages and significant implications. This article is expected to enrich the existing literature substantially, offering a comprehensive analysis of potential strategies for improving diabetes management. With its minimal physical intrusion, light-activated insulin promises to improve patient comfort and treatment adherence. It offers precise regulation and localized impact, potentially mitigating the risks associated with conventional diabetes treatments. Additionally, light-activated insulin is capable of explicitly targeting RNA and epigenetic factors. This innovative approach may pave the way for more personalized and effective diabetes treatments, addressing not only the symptoms but also the underlying biological causes of the disease. The advancement of light-activated insulin could revolutionize diabetes management. This study represents a pioneering introduction to this novel modality for diabetes management.

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Factors associated with adherence or nonadherence to insulin therapy among adults with type 2 diabetes mellitus: A scoping review

Cited by 7 publications

References 52 publications

Investigating the Relationship Between Insulin Treatment Refusal and Psychosocial Factors in Type 2 Diabetic Patients

Investigating the Relationship Between Insulin Treatment Refusal and Psychosocial Factors in Type 2 Diabetic Patients

Current barriers to initiating insulin therapy in individuals with type 2 diabetes

Unraveling Light-Activated Insulin Action in Regulating Blood Glucose: New Photoactivatable Insight as a Novel Modality in Diabetes Management

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