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العنوان
Prevalence and factors affecting
opposition of insulin initiation among
type2 DM patients at Ain Shams
University hospitals /
المؤلف
Ahmed, Eman Mostafa.
هيئة الاعداد
باحث / Eman Mostafa Ahmed
مشرف / Essam Mohammed Bayoumy Helal
مشرف / Diaa Marzouk Abdel Hamid
مناقش / Maha Magdy Mahmoud Wahdan
تاريخ النشر
2018.
عدد الصفحات
187 P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
ممارسة طب الأسرة
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم طب الاسرة
الفهرس
Only 14 pages are availabe for public view

from 187

from 187

Abstract

D
espite the rapid development of new antidiabetic medications, glycemic control is not improving. One of the obstacles to diabetes management is delayed initiation of insulin therapy in poorly controlled type 2 DM patients.
The current study aimed to measure the prevalence of insulin opposition among Egyptian T2DM patients, uncontrolled on two or more oral hypoglycaemic combination therapy at Ain shams university hospitals .Another aim was to assess factors associated with insulin opposition. A cross sectional study was conducted in outpatient clinics at Ain Shams University hospitals using a purposive sample of 103 T2DM patients with poor glycemic control. A semi-structured interview questionnaire was performed.
About half (55.3 %) of the study sample oppsed insulin initiation in spite of poor glycemic control. Comparing opposer and acceptor groups, the negatively stated items that differed significantly between the 2 groups respectively were concern about insulin being a lifelong therapy (84.2% vs 43.5%), delaying insulin as last resort (77.2% vs. 50%), insulin as sign of diabetes severity (75.4% vs. 63 %), feelings of personal failure in self-management (71.9 %vs. 63%), less flexible life (59.6 %vs. 52.2%), time & effort with daily injections (29.8% vs. 13 %) and expected harm from insulin (28.1% vs.13 %).
The positively stated items that differed significantly between opposers and acceptors were about the role of insulin in improving energy level (22.8% vs. 50 %), improving health (28.1% vs. 60.9%) and preventing complications of diabetes (42.1% vs. 67.4%).
In univariate analysis, patients’ characteristics associated with lower opposition to initiate insulin included family history of insulin use, previous physicians’ recommendations on insulin, history of hypoglycemic events and longer duration of diabetes disease.
In multiple logistic regression, ITAS total score, concern about insulin being a lifelong therapy significantly increased insulin opposition. In opposite, physicians’ recommendations significantly decreased insulin opposition.
Recommendations:
When initiating insulin therapy, general practitioners should be more aware of possible opposition to start insulin. Regular training among healthcare providers for effective communication with patients is crucial. Providers should reframe the message about insulin from the time of diagnosis.