Perception of Diabetic Patients Regarding Basal Bolus Insulin Injections and Outcome of its Use.

Abstract

To assess the perceptions regarding basal bolus insulin injections and the changes in blood glucose levels and glycosylated hemoglobin (HbA1c) before and after 3 months of such treatment in diabetic patients. Quasi-experimental study. Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2014 to March 2015. A total of 222 diabetic patients started on basal bolus insulin injection were enrolled and asked to answer 17 questions. Those with complications of diabetes were excluded. Fasting blood glucose (FBS), random blood glucose (RBS) and HbA1c levels were checked initially, and after 3 months of getting basal bolus insulin. Paired t-test and chi-square test were used for determining p-value with significance at p < 0.05. Majority (n=217, 97.7%) of the patients were previously taking other insulins. Before starting this treatment, the mean FBS was 260.5 ±52.2 mg/dl, RBS was 385.5 ±47.61 mg/dl and HbA1c was 12.76 ±1.92%. After 3 months of treatment, FBS improved to 117.9 ±14.2 mg/dl, RBS was 156.7 ±17.09 mg/dl and HbA1c was 7.72 ±4.41% (p < 0.001). Two hundred and sixteen (97.3%) patients believed that basal bolus insulin was started as their diabetes worsened; 157 (70.70%) thought that their blood glucose control would improve with the use of this form of insulin. One hundred and ninety four (87.4%) had fear of needle injections. Perceptions regarding hypoglycemia with this form of insulin were observed in 157 (70.7%). One hundred and twenty seven (84.1%) of the females and 51 (71.8%) of the males thought that the basal bolus insulin regimen was too expensive (p=0.032). There were many misconceptions in patients who were started on basal bolus insulin. Marked improvement in blood glucose levels and HbA1c were observed after the use of this regimen.