Barriers of Insulin Initiation among Type II Diabetes Mellitus Patients in Hospital Pakar Sultanah Fatimah, Muar.

Background Long-term advantages and safety profile of insulin are well documented. However, initiation of insulin therapy is often delayed among patients with Type 2 Diabetes Mellitus (T2DM). This study aim to identify the barriers of insulin initiation and psychological insulin resistance (PIR) factors.

Methods A total of 56 patients with T2DM follow-up at Medical Outpatient Clinic, Hospital Pakar Sultanah Fatimah (HPSF) were involved in this study. Demographic data of the subjects were collected and validated Barriers to Insulin Treatment (BIT) questionnaires were given for participants. The data was analysed with Statistical Package for Social Sciences (SPSS) version 22.

Results Overall, none of the demographic characteristics resulted in high PIR (mean BIT ≥78). Higher mean BIT scores were observed in groups of age 51-65 (68.87, 95% CI 61.11-76.63), males (64.63, 95% CI 56.65-72.61), <5 years T2DM (68.47, 95% CI 58.22-78.72), completed tertiary or above level of education (75.00, 95% CI 54.17- 84.97), and were receiving ≥3 OHAs (74.00, 95% CI 78.56-94.78). However, the comparison within each respective subgroup showed not significant difference. Subscale ‘Scale 5: Fear of hypoglycaemia.’ had the highest mean score per statement (6.04 ± 2.83) and was the only identified barrier with high PIR (average BIT ≥5.57).

Conclusion None of the demographic characteristics resulted in high PIR and the differences within the subgroups were not significant. The main barrier of commencing insulin therapy identified in this study was fear of hypoglycaemia. A further and extensive study is needed to strengthen the evidence found in this study.