Sharma Suresh K, Kant Ravi, Kalra Sanjay, Bishnoi Ravin
College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Division of Diabetes and Metabolism, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Eur Endocrinol. 2020 Oct;16(2):143-147. doi: 10.17925/EE.2020.16.2.143. Epub 2020 Oct 6.
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.
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.
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.
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.
在印度，关于2型糖尿病（T2DM）控制不佳患者首次使用胰岛素后出现原发性不依从的原因，相关数据分析较少。为解决这一问题并试图了解这些原因，我们开展了一项探索性研究，以评估这些患者中胰岛素原发性不依从的患病率以及胰岛素起始治疗的障碍。
研究参与者从印度北阿坎德邦瑞诗凯诗一家三级护理教学公立医院糖尿病门诊的T2DM患者中随机选取，这些患者在过去两年内首次被处方使用胰岛素。所有参与者均接受原发性不依从病史评估，对不依从者随后使用经过修改和验证的半结构化问卷进行面对面访谈，以确定原发性不依从的原因。还与八位医生进行了焦点小组讨论，以了解他们对胰岛素原发性不依从原因的看法。
共识别并访谈了225名患者；其中，105名有原发性不依从病史，并随后接受了面对面访谈。本研究参与者中胰岛素原发性不依从的患病率较高。不依从的主要原因包括自我效能感低、对胰岛素临床益处的怀疑、对低血糖的恐惧、针头恐惧症、胰岛素和血糖监测设备负担不起、对替代药物和神话观念的强烈信仰，以及对胰岛素成瘾及其可能导致快速衰老的恐惧。
鉴于原发性不依从的高患病率及其众多原因，显然我们需要消除这些治疗障碍。因此，在每个糖尿病门诊配备专门的糖尿病教育工作者，以及为贫困人群提供经济有效的胰岛素和血糖监测设备，是实现这一目标的关键。
