Adherence to insulin therapy at a tertiary care diabetes center in South India

Abstract

To assess patient adherence to insulin therapy and factors contributing to non-adherence at a tertiary care diabetes center in South India. Adherence to insulin therapy was assessed in 500 consecutive patients with type 2 diabetes on insulin for at least 3 months, using a 30 point questionnaire – Questionnaire for the Use of Insulin in Diabetes (QUID). Non-adherence was defined as deliberate omission of insulin by the patients at least once a week. Severity of hypoglycemia and reasons for non-adherence and patient attitudes towards insulin therapy were also assessed. Only 28(5.6%) out of 500 patients did not adhere to insulin therapy. Of the 472 patients who adhered to insulin, 416 (88.1%) patients were regular insulin users. The cost of insulin was reported as a major issue by 411 (87%) out of the 472 patients who were adherent to insulin, 61 (12.9%) felt uncomfortable with the injections, 50 (10.6%) felt that it affected their routine activities and 16 (3.4%) reported that it worsened their quality of life (QOL). Hypoglycemia was experienced by 264 (55.9%) patients, and severe hypoglycemia by 21 (4.4%) patients. However, 429 (90.9%) patients reported improved QOL after taking insulin and 434 (91.9%) stated that they would recommend insulin to other patients. Adherence rates to insulin are high in this tertiary diabetes care center in South India. Cost of insulin and hypoglycemia could be the primary factors contributing to insulin non-adherence in our setting.