INSULIN THERAPY;

INCREASING MORBIDITY AND TREND OF REFUSAL AMONG DIABETES MELLITUS TYPE 2 PATIENTS IN PAKISTAN. HEALTHCARE PROVIDER’S PERSPECTIVE

Abstract

Background: The increasing morbidity of diabetes mellitus in Pakistan, and
insulin refusal is one of the main challenges in managing diabetic patients who have suboptimal
control. Objectives: The aim of present study was to determine the trend of insulin therapy
refusal among diabetes mellitus type 2 patients in Pakistan from the healthcare provider’s
perspective and to find out the reasons behind this refusal. Design: Quantitative research study.
Place and duration of study: The clinics of general practitioner & consultants from different
locations of Karachi to cover all socio-economic groups of society to avoid any biasness in
selection. The duration of study is from August 2013 to February 2014. Methods: Four hundred
and fifty healthcare providers were approached with convenient random sampling from
clinics and hospital located in Karachi. The pre-tested and validated questionnaire was used
to collect data. Data were authorized following double entry as given the code number of all
filled questionnaire and then data was first input in the excel sheet and then analyzed further
on Statistical Package for Social Sciences (SPSS). Results: The 4.8% doctor observed that
patients like to use insulin while 95.2% doctor observed that patients did not like to use insulin
and insist to prescribe oral anti diabetic drug instead of insulin. 61.9% doctor believe that their
patient avoid insulin usage due to fear of injection pain, while oral medicine are easy to use,
while 9.5% doctor observed that patient avoid the insulin usage due to fear of poor quality of
life associated with insulin usage, 14.3% doctor believed that their diabetic patient avoid insulin
usage due to fear of addiction or dependent on insulin injection and then oral anti diabetic drug
can never be beneficial for their diabetic management. The 4.8% doctor observed that their
patient avoid the insulin usage due to lack of dispensing facility in their area and they himself
are not able to use insulin injection. The 9.5% doctor observed that their patient avoid insulin
usage due to some other reasons like storage requirement of insulin. Conclusions: The insulin
refusal is seems to be major challenge to healthcare providers in management of diabetes
mellitus type 2 in Pakistan. The proper patients counseling about benefits of insulin need on
urgent basis to improve the situation.