Attitude towards insulin therapy among patients with type 2 diabetes in Tripoli, Libya

Abstract

Background: In patients with type 2 diabetes mellitus (T2DM), failure to control of blood glucose with lifestyle modifications and oral hypoglycemic agents (OHA) leads to insulin therapy. Objectives: We aimed to 1) find out the prevalence of psychological insulin resistance among patients with T2DM and 2) explore the factors affecting and reasons behind their attitude towards insulin use. Patients and methods: In a cross sectional study, 1703 Libyan patients with T2DM on oral hypoglycemic agents (OHA) were studied. They were recruited from outpatient clinics of two hospitals and 5 primary health care centers in Tripoli, Libya over a period of six months. They were asked to complete a self-administered questionnaire. Results: From the total number of 1703 participants, 1611 (94.6%) reported unwillingness to accept insulin therapy should it be prescribed to them. Hesitant patients reported more concerns about possible side effects that may develop from errors in insulin dose than acceptors (73.1% vs 46.7% respectively). 25.6% of the reluctant patients perceived that insulin may cause blindness. Concerns about painful injection of insulin and occurrence of hypoglycemia were expressed by 48.4% and 66.2% of the unwilling group respectively. Conclusion: Psychological insulin resistance is a common obstacle to initiation of insulin therapy in Libyan patients with T2DM. There is an urgent need for enhanced patient education to change the attitude of the patients towards insulin therapy.

Psychological insulin resistance among type 2 diabetic patients attending primary healthcare centers, Al-Ahsa, Saudi Arabia

“…The perception of the type 2 diabetic participants that insulin therapy was painful and that insulin was addictive was also noted in the Libyan study[ 26 ] in which almost 50% of the participants with PIR agreed. The same result was found in the Congo[ 27 ] where the participants who refused insulin were significantly apprehensive of the pain and the possibility of being addicted as compared to those who accepted insulin.…”

“…[ 16 ] A moderately low level of insulin therapy refusal (15%) was found in a Malaysian study, but[ 25 ] a very high level of unwillingness for insulin was reported in a Libyan study in which 94.6% of the participants expressed unwillingness to accept insulin therapy. [ 26 ]…”

“…In a Korean study,[ 23 ] the researchers found that insulin refusal was more among diabetic patients of less duration than those of more duration. [ 23 ] However, one Saudi[ 17 ] as well as one Libyan study[ 26 ] found that there were no significant associations between unwillingness to start insulin with the duration of diabetes. The most pronounced negative attitudes of the participants in our study which led to the PIR were: hearing that some people had had a bad experience with insulin, fear of dependence due to regular injections, lack of time for regular doses of insulin, and inability to pay close attention to diet as insulin treatment requires.…”

Patient perception towards shifting oral antihyperglycemic agents to injectable insulin and associated factors in the diabetes clinic of Tikur Anbessa specialized hospital: Cross-sectional study

“…The finding from the logistic regression analysis showed that, people with primary and secondary education status were 45% and 42% less likely to have poor perception toward shifting OAHAs to insulin, respectively, as compared to those who were unable to read and write (P < 0.05). Similarly, studies in Libya and India found that lower education levels were associated with poor perception [ 20 , 22 ]. This is because as the literacy level increases the level of awareness about diabetes and its treatment will be improved.…”

“…In this study, fear of injections was the most often cited excuse for not taking insulin treatment. Similarly, in a study conducted in the Caribbean nation of Trinidad, Libya, Saudi Arabia, and France among diabetes patients, the perception of painful injections was a barrier to starting insulin therapy [ 12 , [18] , [19] , [20] ]. This aspect should be properly addressed through education, particularly about insulin injection practice.…”