Factors leading to poor adherence to titration of once-daily basal insulin among patients with Type 2 Diabetes Mellitus

ABSTRACT

Introduction@#Given the increasing burden of diabetes worldwide as well as in the Philippines, understanding factors affecting diabetes management is crucial. We investigated the factors leading to poor adherence to titration of longacting, once a day, basal insulin among patients with type 2 diabetes mellitus (DM) seen at the outpatient department (OPD) clinics of St. Luke’s Medical Center, Quezon City.@*Methods@#This qualitative study included semi-structured individual interviews and focus group discussions (FGD). A total of 43 type 2 DM patients using once a day, basal insulin participated. 22 patients had one-on-one interviews while 21 patients were divided into three separate FGDs. Data were analyzed using thematic analysis.@*Results@#More than half (53.5%) of the type 2 DM patients included in this study did not have any method of titration of their once-daily basal insulin despite being taught by their attending physicians. The categorized themes identified were the following patient-centered, treatment-related, healthcare system-related, and psychological/social factors.@*Conclusion@#Lack of income or financial support, fear of insulin injection and its side effects, high cost of insulin, inaccessibility of medical assistance from healthcare facilities, negative attitude/fear of titration, and difficulty complying to lifestyle changes were some of the identified factors leading to poor adherence to the titration of once-daily basal insulin in this study. Good, constant communication between the patient and the doctor appears to improve adherence to insulin dose titration. Future studies may adapt the themes and concepts identified to improve adherence to titration of once-daily basal insulin among patients with type 2 DM.