Factors Affecting Opposition of Insulin Initiation Among Type 2 DM Patients at Ain Shams University Hospitals

Abstract

Background: One of the obstacles to diabetes management is delayed insulin initiation in uncontrolled type 2DM patients. Objectives: To measure the frequency of insulin opposition among Egyptian type 2 diabetes patients, uncontrolled, on two or more oral hypoglycemic combination therapy and to assess factors associated with insulin opposition. Methods: Cross-sectional study was conducted in outpatient clinics at Ain Shams University hospitals, on purposive sample of 103 type 2 diabetic patients, uncontrolled, on two or more oral hypoglycemic combination therapy, using a structured questionnaire. Results: Uncontrolled type 2DM patients opposed to start insulin were 55.3%. The most common negative attitudes that differ significantly between insulin opposers and acceptors were: insulin as last resort (77.2% vs 50%), perceived diabetes severity (75.4% vs 63 %), concerns about less flexibility (59.6 %vs 52.2%), time and effort with insulin injections (29.8% vs 13 %) and expected harm from insulin (28.1% vs 13 %). Opposers had significantly less agreement on positive items regarding the role of insulin in improving energy level (22.8% vs 50%), improving health (28.1% vs 60.9%), and preventing complications of diabetes (42.1% vs 67.4%). Conclusion and recommendations: high rate of insulin opposition among uncontrolled type 2DM and its associated factors among T2DM patients, therefore, the need for increasing physicians’ awareness through training sessions is important to improve the strategy for identifying and reducing insulin opposition among patients.