Prevalence of unwillingness to use insulin therapy and its associated attitudes amongst patients with Type 2 diabetes in Saudi Arabia

Abstract

Aims: This study aimed at determining the prevalence of unwillingness to use insulin and its associated attitudes amongst participants with Type 2 diabetes in Saudi Arabia. A further aim was to investigate whether demographic characteristics such as age, gender, educational level and duration of diabetes are associated with unwillingness to use insulin among these participants.

Methods: This is a cross-sectional study conducted among participants with Type 2 diabetes using a self-administered questionnaire. The study sample consisted of 408 insulin-naive participants with Type 2 diabetes who were recruited between May and August 2014 from the primary care outpatient clinics at King Khalid University Hospital in Riyadh, Saudi Arabia.

Results: Unwillingness to commence using insulin was common in about one third (34.6%) of Saudi participants with Type 2 diabetes. Negative attitudes most frequently raised by participants towards commencing insulin therapy were: keeping insulin as a last resort (57.1%), restriction of lifestyle (48.8%), problematic hypoglycemia (45.1%), perception of failure to care for diabetes previously (44.6%), and weight gain worries (40.7%). In a multivariable logistic regression analysis, after adjustment for a participant's age, gender, educational level, location and duration of diabetes, participants with tertiary education were 48% less likely to be willing to initiate insulin therapy as compared to those who had only a primary education (OR=0.52, 95% CI=0.30-0.91, P=0.023). However, there were no significant associations between unwillingness to commence insulin and other study variables.

Conclusions: Participants have several negative attitudes concerning initiating insulin therapy. Exploring the reasons for participant reluctance to commence insulin can help address his or her specific concerns and beliefs, and promote the future uptake of insulin.

Keywords: Insulin; Insulin resistance; Patient experience; Primary care; Psychologically; Questionnaire; Refusal; Type 2 diabetes.