Fu Sau Nga, Wong Carlos King Ho, Chin Weng Yee, Luk Wan
Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, G/F, Ha Kwai Chung General Outpatient Clinic, 77 Lai Cho Road, Kwai Chung, Kowloon, Hong Kong S.A.R., China.
Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, 3/F., 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong S.A.R., China.
J Diabetes Metab Disord. 2016 Feb 24;15:3. doi: 10.1186/s40200-016-0223-0. eCollection 2015.
Delay in commencing insulin among type 2 Diabetes Mellitus (DM) patients is common. One of the reasons is patients' psychological insulin resistance, which is particularly prevalent in Chinese patients. This study examined the correlation between socio-demographic and clinical characteristics; and attitudes towards commencing insulin in Chinese primary care patients.
A cross-sectional survey was conducted on 303 insulin-naïve Type 2 DM patients recruited from 15 primary care clinics across Hong Kong using the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ). Subject selection criteria were patients on maximal oral anti-diabetes treatment who needed to commence insulin therapy. Linear regression was used to identify correlations between age, sex, educational level, occupation, body mass index, diabetes disease duration, laboratory test indicating disease control and biochemical markers including glycosylated hemoglobin (HbA1c) level, low density lipoprotein level and estimated glomeruli filtration rate, and presence of diabetic complications with the four sub-scales (self-image and stigmatization; factors promoting self-efficacy; fear of pain or needles; time and family support ) and the overall Ch-ASIQ score.
The most prevalent negative attitude was 'fear of needle injections' (70.1 %). The most common positive attitude was 'I can manage the skill of injecting insulin' (67.5 %). The mean Ch-ASIQ score of 2.50 (S.D. = 0.38) was equal to the mid-score, which signified an overall ambivalent attitude among the study population. Women scored significantly higher in the fear of pain or needles subscale (p = 0.011) and had an overall more negative attitude towards commencing insulin (p = 0.016). Subjects with lower HbA1c levels also had a significantly lower Ch-ASIQ sum score (p = 0.048) indicating a more negative attitude towards commencing insulin.
In Chinese primary care patients with Type 2 DM, the need to commence insulin was associated with a number of negative emotions, which lead to a lower motivation to accept treatment. Perception of need as indicated by HbA1c level may be an important influencing factor determining a patient's overall attitude towards starting insulin. Fortunately, in our setting, the injection technique does not appear to be a major barrier. However, needle fears are common, especially amongst women. Target interventions to acknowledge and help them to overcome their fears are essential before insulin treatment is commenced.
2型糖尿病（DM）患者开始使用胰岛素的延迟情况很常见。原因之一是患者的心理性胰岛素抵抗，这在中国患者中尤为普遍。本研究调查了社会人口统计学和临床特征与中国基层医疗患者开始使用胰岛素的态度之间的相关性。
使用中国开始使用胰岛素态度问卷（Ch-ASIQ）对从香港15家基层医疗诊所招募的303名未使用过胰岛素的2型糖尿病患者进行了横断面调查。受试者选择标准为正在接受最大剂量口服抗糖尿病治疗且需要开始胰岛素治疗的患者。采用线性回归分析年龄、性别、教育程度、职业、体重指数、糖尿病病程、表明疾病控制的实验室检查以及包括糖化血红蛋白（HbA1c）水平、低密度脂蛋白水平和估算肾小球滤过率在内的生化指标，以及糖尿病并发症的存在与四个子量表（自我形象与污名化；促进自我效能的因素；对疼痛或针头的恐惧；时间与家庭支持）和Ch-ASIQ总分之间的相关性。
最普遍的消极态度是“害怕打针”（70.1%）。最常见的积极态度是“我能掌握注射胰岛素的技巧”（67.5%）。Ch-ASIQ平均得分为2.50（标准差=0.38），处于中等分数，这表明研究人群总体态度矛盾。女性在对疼痛或针头的恐惧子量表上得分显著更高（p=0.011），并且对开始使用胰岛素总体态度更消极（p=0.016）。HbA1c水平较低的受试者Ch-ASIQ总分也显著较低（p=0.048），表明对开始使用胰岛素的态度更消极。
在中国基层医疗的2型糖尿病患者中，开始使用胰岛素的需求与多种负面情绪相关，这导致接受治疗的动力较低。HbA1c水平所表明的需求认知可能是决定患者对开始使用胰岛素总体态度的一个重要影响因素。幸运的是，在我们的研究环境中，注射技术似乎不是主要障碍。然而，对针头的恐惧很常见，尤其是在女性中。在开始胰岛素治疗之前，进行针对性干预以认识并帮助他们克服恐惧至关重要。
