Rejection of insulin therapy among patients with type 2 diabetes in China: reasons and recommendations.

Zhenzhen Xiong; Li Yuan; Xiaohui Guo; Qingqing Lou; Fang Zhao; Li Shen; Mingxia Zhang; Zilin Sun

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Rejection of insulin therapy among patients with type 2 diabetes in China: reasons and recommendations.

Author: Zhenzhen XIONG ¹ ; Li YUAN ² ; Xiaohui GUO ³ ; Qingqing LOU ⁴ ; Fang ZHAO ⁵ ; Li SHEN ⁶ ; Mingxia ZHANG ⁷ ; Zilin SUN ⁸
Author Information

1. Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
2. Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China. Email: ylhxyy@163.com.
3. Department of Endocrinology, First Hospital of Peking University, Beijing 100034, China.
4. Department of Health Education, Jiangsu Province Integrated Chinese and Western Medicine Hospital, Nanjing, Jiangsu 210028, China.
5. Department of Endocrinology, China-Japan Friendship Hospital, Beijing100029, China.
6. Beijing Tsinghua Hospital, Beijing 102218, China.
7. Department of Endocrinology of Peking University People's Hospital. Beijing 100034, China.
8. Department of Internal Medicine, Southeast University Zhongda Hospital, Nanjing, Jiangsu 210009, China.
Publication Type:Journal Article
MeSH: China; Cross-Sectional Studies; Diabetes Mellitus, Type 2; drug therapy; Female; Humans; Insulin; therapeutic use; Male; Middle Aged; Patient Acceptance of Health Care; statistics & numerical data; Surveys and Questionnaires
From: Chinese Medical Journal 2014;127(20):3530-3536
CountryChina
Language:English
Abstract:
BACKGROUNDInsulin injection therapy is one of the most effective treatments for type 2 diabetes mellitus (T2DM). Many people with T2DM in western countries resist starting insulin therapy; whether the same is true in China is unknown. This survey-based study assessed acceptance and rejection of insulin therapy among individuals with T2DM in China and self-reported reasons for these therapy choices. It also examined what methods may be useful for increasing the rate of insulin acceptance.
METHODSA multi-center, cross-sectional survey was conducted between April and July 2010 to a convenience sample of inpatients and outpatients at 50 medical centers across 29 administrative divisions in China. Data were collected on sociodemographic and T2DM characteristics, therapy regime, and attitudes toward insulin therapy.
RESULTSA total of 6 043 patients were surveyed, and 5 961 complete questionnaires (98.6%) were used in the analysis. Just over half the respondents (3 460, 58.0%) reported negative attitudes to insulin therapy, including 2 508 of the 4 469 patients (56.1%) whose physicians had recommended it to them. Of the patients counseled to use insulin, 800 (17.9%) were unwilling to start therapy and cited the following reasons: inconvenience (64.3%); concerns over addiction (24.6%); pain (14.3%); side effects (14.1%); and high cost (13.6%). Logistic regression suggested that respondents would be more willing to undertake insulin therapy if they had received diabetes education, had positive attitudes to the treatment, had higher glycosylated hemoglobin level, or had suffered diabetes for a longer period or with more complications.
CONCLUSIONSPatients with T2DM in China are often resistant to insulin therapy if they have been diagnosed with the disease for a relatively short time or if the disease has been relatively mild. Educating patients on the benefits of insulin therapy, not only at the initial diagnosis with T2DM but also when insulin therapy becomes necessary, will likely increase their willingness to undertake it.