<p>The barriers against initiating insulin therapy among patients with diabetes living in Yazd, Iran</p>

Abstract

Introduction The decision to start insulin therapy is often difficult. Determining the barriers against insulin therapy initiation can facilitate care and treatment strategies. The aim of this study was to evaluate the barriers against initiating insulin therapy among patients with diabetes living in Yazd, Iran. Methods This descriptive study was conducted on 214 patients referred to the Diabetes Center of Yazd University of Medical Sciences in 2015. Participants were randomly selected, and then they completed the insulin noncompliance questionnaire (20 questions). The percentage of adherence and the factors contributing to nonadherence to insulin therapy were analyzed using descriptive statistics, the Kruskal–Wallis test, and the Mann–Whitney test. Results The most prevalent reason for insulin therapy refusal was expecting a new method of diabetes treatment (54.7%), followed by requiring someone else to administer the injection (19.2%), fear of needles, cost, traveling (18.7%), and stress/emotional problems (18.2%). Lack of trust in the physician was the least restrictive reason for nonadherence to insulin therapy. Conclusion The most common reason given for insulin therapy refusal was the lack of adequate education. Therefore, specialized educational interventions can help minimize barriers and improve patients’ outcomes.

The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review

“…Twenty articles addressed diabetes [ 3 , 34 – 44 , 46 – 53 ], seven addressed chronic kidney disease [ 1 , 28 – 33 ], and five addressed cancer [ 2 , 24 – 27 ].…”

“…Of non-insulin dependent patients with type 2 diabetes 56/200 (28%) were unwilling to receive insulin, with 50% citing anticipated pain and “inability to take” needling every day as a key reason (although not clear if this was due to distress or anxiety) [ 41 ]. Similarly, 67/214 (31%) diabetic patients who initially refused insulin or who received insulin administration by a physician indicated fear of needles as a barrier [ 44 ]. Among Type 2 diabetic patients more than half 243/468 (52%) expressed unwillingness to start insulin therapy, the attitudinal items from the administered questionnaire that most strongly distinguished unwilling from willing participants included injection-related anxieties including fear of needles, with 218/243 (90%) of unwilling patients being afraid of needles compared to 130/225 (58%) of willing patients [ 52 ].…”

“…Measures that assess needle fear in the context of a therapy, such as the D-FISQ, should be utilised where available. Screening may be warranted particularly prior to treatment initiation, as needle fear is associated with treatment refusal [ 1 , 33 , 40 , 44 , 52 ], or in the early weeks and months of therapy, when fear appears heightened [ 1 , 42 , 43 , 55 ]. Early identification of patient fear or misconceptions of therapy could aid in treatment-decision making and provide opportunity for education and early intervention.…”

Current Pharmacological Treatment of Type 2 Diabetes Mellitus in Undocumented Migrants: Is It Appropriate for the Phenotype of the Disease?

“…Other factors can also affect the different distribution of insulin treatment among clusters. For example, social or psychologic barriers to its use [40,41] could be important, and this in turn could be responsible for worse metabolic control [42]. Not unexpectedly, oral antidiabetic agents followed a comparable pattern of distribution, with the use of three or more medications being more frequent in cluster 3 and 4.…”

Assessing Barriers to Insulin Therapy among Omani Diabetic Patients Attending Three Main Diabetes Clinics in Muscat, Oman

“…These items were adopted and modified from previous similar studies. [18][19][20] The constructed questionnaire was subsequently validated by three subject experts for content, appropriateness, and relevance. A four-point Likert Scale was used to classify the importance of each barrier as 'not at all important', 'sometimes important', 'frequently important', or 'very important'.…”