The Barriers to Initiating Insulin Therapy among People with Type 2 Diabetes in Taiwan - A Qualitative Study

Abstract

Insulin therapy often becomes necessary when oral hypoglycemic agents are no longer effective. However, the rate of initiating insulin treatment is low among people with type 2 diabetes in Taiwan. A qualitative study was done at the diabetes centers of two hospitals and consisted of face-to-face interviews of patients who were reluctant to start insulin treatment. The results of interviews were subjected to Framework Analysis for emergent concepts and category system. There were 15 people (10 women, 5 men) who were interviewed, ages between 46 to 71 years old (mean age 59.7±7.3 years). We categorized the barriers of initiating insulin treatment as 1) Reluctance of physicians 2) Misconceptions about insulin 3) Low adaptation capacity 4) Needle phobia 5) Psychological insulin resistance. These barriers interfered with decisions to begin insulin treatment. To break these barriers, responsibility and decision-making should be placed upon caregivers for people with low adaptation capacity. Needle phobia should be looked at as a disease entity and addressed with greater patience. The possibility and benefits of insulin treatment should be included early in diabetes education. Physicians should adhere to the guidelines for initiation of insulin treatment and empower patients.