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

Abstract

BACKGROUND: Patients' adherence to insulin therapy is crucial to achieve good glycemic control. The present study was conducted to determine psychological insulin resistance (PIR) and the effect of doctor–patient relationship on PIR among type 2 diabetes patients attending primary health-care centers of Al-Ahsa region in Saudi Arabia. MATERIALS AND METHODS: This was a cross-sectional survey of all type 2 diabetic patients attending the primary healthcare centers of Al-Ahsa. A multistage sampling technique was used. The calculated sample size was 396. Two validated structured questionnaires were used to collect information. The degree of agreement to insulin therapy was done on the Likert 5° scale. SPSS was used for data entry and analysis. Chi-square test was used to test for stistical significane at P=0.05. RESULTS: Out of 396 patients who were given the questionnaires, 366 filled the questionnaires yielding 92% response rate. Fifty-one percent were male and about 85% were older than 35 years. Willingness to use insulin was significantly associated with age ( P = 0.013) and duration of diabetes (P=0.0001). The strongest negative attitudes toward insulin therapy arose from participants having heard about a bad experience with insulin (59.34%, P < 0.05) and the fear of possible dependence (54.20%, P < 0.05). Participants who responded of “mostly appropriate” and “very appropriate” to questions on patient–doctor relationship were significantly more willing to take insulin (64.9% vs 24.5%, and 70.3% vs 22.9%, P = 0.0001). CONCLUSION: The study showed that one-third of the patients with type 2 diabetes had PIR. Since the behavior of doctor plays an important role in reducing PIR, there is a need for greater emphasis on the importance of good doctor–patient relationship and the establishment of a therapeutic education program.

Insulin for Individuals with Diabetes A Photovoice Study

“…In the study conducted by Allen et al (2017), it was stated that almost 1/3 of the patients who needed to use insulin did not plan to start using it (Allen et al, 2017). Another study reported that approximately 70% of users had a negative attitude towards insulin (Alomran et al, 2020). Although 58.5% of the patients who stopped using insulin stated that they experienced other adverse events after discontinuation (Soylar et al, 2020), the rate of discontinuation of insulin therapy was reported as 6.2% (Karabayraktar et al, 2017).…”

“…In the study of Alomran et al (2020), it is explained that men, those between the ages of 35 and 50, those who have not studied at university, those who are in the first 5 years of diabetes diagnosis are at risk of insulin use, cannot use it regularly or are likely to quit (Alomran et al, 2020). Another study, on the contrary, shows that women, those aged >65, are more likely to give up insulin, while the group with low levels of education, and especially those who have not studied diabetes, do not want to use Insulin.…”

“…Participant Information form: Consisted of 12 questions based on the literature (Allen et al, 2017;Alomran et al, 2020;Bermeo-Cabrera et al, 2018;Holmes-Truscott et al, 2018) questioning the socio-demographic and insulin use of the participants.…”

“…Individuals with diabetes may worry that they will be worse off when they use insulin because they have not been able to get the right information about diabetes, treatment, and self-care (Allen et al, 2017). It is stated that the experience of worsening of the general condition after unconscious use of insulin and the fear of addiction is effective in this (Alomran et al, 2020). The necessity of executing insulin several times a day also affects individuals negatively.…”

“…The most important factor in ensuring the adequacy and continuity of diabetes treatment is diabetes selfgovernment (Gulam et al, 2017). In general, studies show that patients' drug compliance is not very good, there is a negative perception towards insulin, and the reasons for this should be investigated (Allen et al, 2017;Alomran et al, 2020;Arda Sürücü & Samancıoğlu, 2018;Bermeo-Cabrera et al, 2018;Gulam et al, 2017;Holmes-Truscott et al, 2018;Holmes-Truscott et al, 2017;Karabayraktar et al, 2017;Soylar et al, 2020). It is stated that the education of diabetic individuals should be updated using the results of the research (Karabayraktar et al, 2017).…”