Challenges with Insulin Use Among Patients with Type 2 Diabetes Mellitus: Focus on a Tertiary Healthcare Setting in South-East Nigeria.

Abstract

Effective usage of insulin in the management of diabetes remains a challenge in developing countries like Nigeria. The objective of this study is to document the pattern of insulin prescription, frequency, storage, common regimen used, and attendant problems associated with its use in patients with type 2 diabetes mellitus (T2DM). This was a prospective, descriptive study in which consecutive T2DM patients seen at the medical out-patient clinic and medical wards and who fulfilled the criteria for inclusion were recruited. Participants provided information on their demographic characteristics, diabetes history, treatment and problems associated with treatment, type of insulin in use, number of daily injections, storage, method of insulin administration and problems associated with insulin use. Clinical examination was carried out basically to determine the anthropometric indices. About 84.3% have used insulin for less than 5 years. The thigh was the commonest site of insulin administration (95.3%). About 94.3% of subjects in this study store their insulin in a refrigerator. And Insulin dosing regimen ranged from less than once to four times daily while majority of patients (63%) were on twice daily insulin regimen. Insulin administration devices used were Insulin syringes 394 (98.5%) and Insulin pens 6 (1.5%). Thirty three percent of the subjects self inject insulin while about half of the study subjects (50.5%) receive insulin from a healthcare provider. The most common insulin used by patients was Mixed/ Premixed insulin (32.8%) and Regular/ Soluble insulin (38.8%). Hypoglycaemia was the most frequently documented problem encountered by subjects on insulin followed by weight gain. Majority of the study subjects (50.8%) practice self monitoring of blood glucose (SMBG). This study has demonstrated that majority of subjects with T2DM were on premixed insulin and that hypoglycaemia is the most common problem reported by patients. Insulin pens were not common among our study population.