Insulin Adherence and Associated Factors in Patients with Type 2 Diabetes Mellitus Treated in Klang Primary Health Care Centres

Background: Insulin therapy is necessary for patients with type 2 diabetes mellitus (T2DM) to reach the targeted glycaemic level and prevent complications. This study aimed to determine the proportion of adherence to insulin therapy and the associated factors in patients with T2DM.

Methods: A cross-sectional study was conducted among 249 patients with T2DM who had been on insulin therapy for at least 2 months in primary care centres of the Ministry of Health in Klang, Malaysia. A validated insulin adherence questionnaire for diabetes mellitus (DM) was used to assess insulin adherence. Data on the sociodemographic characteristics, disease-related factors, treatment-related factors and clinical parameters were extracted from medical records and interviews with patients.

Results: The adherence to insulin therapy was 8.43%. The factors associated with insulin adherence were self-monitoring of blood glucose (SMBG) (adjusted odds ratio [AOR]: 5.39; 95% confidence interval (CI): 1.20, 24.13; P = 0.028), exercise (AOR: 3.38; 95% CI: 1.37, 10.03; P = 0.029) and the number of daily insulin injections (AOR: 1.63; 95% CI: 1.09, 2.44; P = 0.017).

Conclusion: The adherence to insulin therapy in primary health care centres in Malaysia was very poor. Patients who practiced SMBG, exercised and frequent daily insulin injections were significantly more adherent to insulin therapy.