Prevalence and reasons for insulin refusal in Bangladeshi patients with poorly controlled Type 2 diabetes in East London
- 29 August 2008
- journal article
- research article
- Published by Wiley in Diabetic Medicine
- Vol. 25 (9), 1108-1111
- https://doi.org/10.1111/j.1464-5491.2008.02538.x
Abstract
Aims To determine the prevalence and reasons for refusal to commence insulin in Bangladeshi patients with Type 2 diabetes. Methods A survey of 212 Bangladeshi patients seen in a hospital diabetes unit, with poor glycaemic control (HbA(1c) >= 8.0%) on maximum oral glucose-lowering therapy, in whom insulin was deemed necessary. Patients who refused insulin were invited to attend focus groups. Data were analysed by thematic content analysis using the constant comparative method. Results Of 212 patients offered insulin, 122 (57.5%) commenced insulin immediately, 47 (22.1%) started insulin within 6 months and 43 (20.3%) refused to commence insulin despite repeated counselling. Thirty-six (83.7%) of those who refused insulin agreed to participate in focus groups. Reasons for insulin refusal included: disease severity-perceptions that requirement for insulin was an indicator of a more serious stage of their condition; insulin leading to premature death-common suggestion that commencing insulin led to early death; loss of control-including fear of hypoglycaemia, weight gain, loss of independence and reliance on others to give insulin or look for signs of hypoglycaemia; lack of perception of benefits-poor perception of the benefits of improved glycaemic control on quality of life and cardiovascular risk; needle anxiety-a significant proportion of subjects conveyed concern over frequent injections. Conclusions Insulin refusal is common in Bangladeshi subjects with Type 2 diabetes and poor glycaemic control. A number of factors contribute to this, and methods to overcome the barriers to insulin therapy need to be sought.Keywords
This publication has 9 references indexed in Scilit:
- Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 DiabetesThe New England Journal of Medicine, 2007
- Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of TherapyDiabetes Care, 2006
- Resistance to Insulin Therapy Among Patients and ProvidersDiabetes Care, 2005
- What's So Tough About Taking Insulin? Addressing the Problem of Psychological Insulin Resistance in Type 2 DiabetesClinical Diabetes, 2004
- Injection related anxiety in insulin-treated diabetesDiabetes Research and Clinical Practice, 1999
- Health beliefs and folk models of diabetes in British Bangladeshis: a qualitative studyBMJ, 1998
- Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UKDiabetic Medicine, 1998
- NIDDM Patients' Fears and Hopes About Insulin Therapy: The basis of patient reluctanceDiabetes Care, 1997
- Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London.Heart, 1988