MON-171 Diabetics' Perceptions about Insulin Are Major Barriers to Its Early Initiation: A Cross-Sectional Study

Diabetes mellitus is a chronic progressive illness that causes considerable morbidity related to macro and micro vascular complications, resulting in an ever growing healthcare burden globally. Early Initiation of Insulin has significant impact on improving both long term health outcomes and quality of life among diabetics in comparison to oral medications alone. But both patients and physicians often resist early initiation of therapy, a phenomenon known as “Psychological Insulin Resistance” (PIR). Objective of study was to assess such barriers among diabetic patients in Pakistan. We selected 300 patients both type 1 and 2 through convenience sampling from diabetic clinics of 2 tertiary care hospitals. Data was collected through structured questionnaires and analyzed using SPSS version 17. A p-value <0.05 was considered statistically significant. (1)Variables i.e. embarrassment about injecting insulin in public, expense, affordability and side effects ( skin reactions, injection site pain) of insulin, frequent shots and interference with social activities when cross tabulated with gender of participants, educational status and duration of disease, were found statistically significant (p-value <0.05) proving them possible barriers to early initiation of therapy. Results were comparable to a study conducted on type 2 diabetics in Mexico to assess insulin adherence. (2). It was also observed that people with longer (>5 years) and advanced disease were more satisfied about their glycemic control with insulin and willing to recommend it to others but at the same time, feared about its lifelong commitment once started, with all these variables having statistical significance (p-value<0.05) .Although only patients perceptions were assessed but results were comparable with DAWN study in which belief in insulin efficacy was stronger among patients with poor control of disease and more distress. Concluded that patient’s perceptions and misconceptions arise from lack of primary education about long term benefits of insulin and prove major barriers to its early initiation. Patients consider insulin efficacious and last resort when they develop complications. Such perceptions tend to prevail more in areas of poor socioeconomic background and high illiteracy rate. Reference: (1) Bermeo et al., Insulin Adherence in Type 2 Diabetes: Jul 15; 2018 (2) Peyrot et al., Diabetes Attitudes, Wishes, and Needs (DAWN) study. 2005; 28 :2673-79