Young onset diabetes patients in Asia represent a heterogeneous group in terms of their clinical and biochemical characteristics and classical Type 1 diabetes is relatively uncommon. The 5-year follow up study will determine the progress of these patients and help to clarify the natural history.

Aim:  To determine the factors that deter the initiation of insulin therapy among type 2 diabetes patients with secondary drug failure. Methods:  An observational cross sectional study of 72 refusors (cases) and 72 acceptors (controls) of insulin therapy in primary care polyclinics in Singapore. Results:  Refusors have more concerns about insulin injections than acceptors (69.4 vs 22.2%, p < 0.001). Refusors cited ‘fear of pain from the needle’ as the main reason for refusing to start insulin therapy (45.8%), followed by ‘financial constraint’ (18.4%) and ‘inconvenience’ (12.5%). Refusors were less aware of the action of insulin (58.2 vs 34.6%, p = 0.015), perceived that insulin ‘is unnecessary (because) other treatment is available’ (70.8 vs 36.1%, p = 0.001) and regard regular injections as a hassle (50 vs 26.4%, p = 0.001). Acceptors were more likely to perceive insulin injection as ‘effectively controls blood glucose levels’ (84.7 vs 59.7%, p = 0.002), ‘helps one feel better’ (77.8 vs 40.3%, p = 0.001), ‘helps one feel more energetic’ (68.1 vs 31.9%, p = 0.001), and ‘more effective than oral medication’ (72.2 vs 43.1%, p = 0.001). Nonetheless, both groups were as likely to perceive that being put on insulin therapy is an indication of an ‘advanced phase of illness’ (65.3 vs 63.9%, NS), and a ‘failure to care for oneself’ (66.7 vs 55.6%, NS). Conclusions:  The two major barriers to insulin initiation among refusors are perception of pain and financial constraints. Refusors are more likely than acceptors to have concerns over insulin injection and regard insulin therapy as a last resort, although both groups possessed a number of negative perceptions regarding insulin therapy, which need to be addressed.

The Inadequate metabolic and hypertension control, especially in type 2 patients, needs to be addressed.

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