PMID- 33117446
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201030
IS  - 1758-3780 (Electronic)
IS  - 1758-3772 (Print)
IS  - 1758-3772 (Linking)
VI  - 16
IP  - 2
DP  - 2020 Oct
TI  - 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.
PG  - 143-147
LID - 10.17925/EE.2020.16.2.143 [doi]
AB  - 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.
CI  - (c) Touch Medical Media 2020.
FAU - Sharma, Suresh K
AU  - Sharma SK
AD  - College of Nursing, All India Institute of Medical Sciences, Rishikesh, 
      Uttarakhand, India.
FAU - Kant, Ravi
AU  - Kant R
AD  - Division of Diabetes and Metabolism, All India Institute of Medical Sciences, 
      Rishikesh, Uttarakhand, India.
FAU - Kalra, Sanjay
AU  - Kalra S
AD  - Department of Endocrinology, Bharti Research Institute of Diabetes and 
      Endocrinology (BRIDE), Karnal, Haryana, India.
FAU - Bishnoi, Ravin
AU  - Bishnoi R
AD  - Division of Diabetes and Metabolism, All India Institute of Medical Sciences, 
      Rishikesh, Uttarakhand, India.
LA  - eng
PT  - Journal Article
DEP - 20201006
PL  - England
TA  - Eur Endocrinol
JT  - European endocrinology
JID - 101574781
PMC - PMC7572173
OTO - NOTNLM
OT  - Insulin
OT  - diabetes
OT  - medication
OT  - non-adherence
OT  - self-efficacy
COIS- 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.
EDAT- 2020/10/30 06:00
MHDA- 2020/10/30 06:01
PMCR- 2020/10/01
CRDT- 2020/10/29 05:52
PHST- 2020/03/11 00:00 [received]
PHST- 2020/04/20 00:00 [accepted]
PHST- 2020/10/29 05:52 [entrez]
PHST- 2020/10/30 06:00 [pubmed]
PHST- 2020/10/30 06:01 [medline]
PHST- 2020/10/01 00:00 [pmc-release]
AID - 10.17925/EE.2020.16.2.143 [doi]
PST - ppublish
SO  - Eur Endocrinol. 2020 Oct;16(2):143-147. doi: 10.17925/EE.2020.16.2.143. Epub 2020 
      Oct 6.