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      Prevalence of Primary Non-adherence with Insulin and Barriers to Insulin Initiation in Patients with Type 2 Diabetes Mellitus – An Exploratory Study in a Tertiary Care Teaching Public Hospital

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          Abstract

          Introduction: There is a paucity of data analysing the reasons for primary non-adherence following first prescription of insulin among patients with uncontrolled type 2 diabetes mellitus (T2DM) in India. To address this, and to attempt to understand these reasons, an exploratory study was undertaken to assess the prevalence of primary non-adherence with insulin and barriers to insulin initiation in these patients. Methods: Study participants were randomly selected from patients with T2DM who visited the diabetes clinic of a tertiary care teaching public hospital in Rishikesh, Uttarakhand, India, and were prescribed insulin for the first time in last 2-year period. All participants were evaluated for history of primary non-adherence, and those who were non-adherent were subsequently interviewed face-to-face using a modified, validated semi-structured questionnaire to identify the reasons for primary non-adherence. A focused group discussion was also conducted with eight physicians to elicit their views about reasons for primary non-adherence with insulin. Results: A total of 225 patients were identified and interviewed; of these, 105 were identified with a history of primary non-adherence and underwent a subsequent face-to-face interview. There was a high prevalence of primary non-adherence with insulin among the participants of this study. The main reasons for non-adherence were low self-efficacy, doubt about clinical benefits of insulin, fear of hypoglycaemia, needle phobia, unaffordability of insulin and blood glucose monitoring device, strong faith in alternative medicines and mythical ideologies, and fears of insulin being addictive and that it may cause rapid aging. Conclusion: With the high prevalence of primary non-adherence, and the multitude of reasons for this, it is clear that we need to eliminate these barriers to treatment. Thus, provision of dedicated diabetes educators in each diabetes clinic and availability of cost-effective insulin and blood glucose monitoring devices for the underprivileged population are key to achieve this.

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          Author and article information

          Journal
          Eur Endocrinol
          Eur Endocrinol
          EE
          European Endocrinology
          Touch Medical Media
          1758-3772
          1758-3780
          October 2020
          06 October 2020
          : 16
          : 2
          : 143-147
          Affiliations
          [1 ] College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,
          [2 ] Division of Diabetes and Metabolism, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,
          [3 ] Department of Endocrinology, Bharti Research Institute of Diabetes and Endocrinology (BRIDE), Karnal, Haryana, India,
          [4 ] Division of Diabetes and Metabolism, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,
          Author notes
          Corresponding Author: Suresh K Sharma, College of Nursing, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand, India. E: sk.aiims17@ 123456gmail.com

          Disclosures: Suresh K Sharma, Ravi Kant, Sanjay Kalra and Ravin Bishnoi have no financial or non-financial relationships or activities to declare in relation to this article. Sanjay Kalra is a member of the journal’s Editorial Board.

          Article
          PMC7572173 PMC7572173 7572173
          10.17925/EE.2020.16.2.143
          7572173
          33117446
          6685d03a-1f45-43ad-8e7d-df87411ed7eb
          © Touch Medical Media 2020

          ali:free_to_read

          www.copyright.com

          Access: This article is freely accessible at touchENDOCRINOLOGY.com © Touch Medical Media 2020.

          Review Process: Double-blind peer review.

          Compliance with Ethics: The research project was approved by Institutional Ethical Committee, AIIMS, Rishikesh, India, and informed written consent was obtained from each participant for voluntary participation in the study.

          Data Availability: The datasets during and/or analysed during the current study are available from the corresponding author on reasonable request.

          Authorship: The named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

          History
          : 11 March 2020
          : 20 April 2020
          Page count
          Pages: 5
          Funding
          Support: No funding was received in the publication of this article.
          Categories
          Diabetes

          self-efficacy,Insulin,diabetes,medication,non-adherence
          self-efficacy, Insulin, diabetes, medication, non-adherence

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