Factors influencing poor glycaemic control in people with type 2 diabetes using insulin: a qualitative study / Tong Wen Ting

Diabetes has seen major advancement in its diagnosis and treatment especially with the advent of insulin therapy, the most effective glycaemic lowering agent currently available. Unfortunately, many people with type 2 diabetes mellitus (T2DM) using insulin still fail to achieve good glycaemic control. This study aimed to explore the factors influencing poor glycaemic control among people with T2DM patients using insulin. This study used a qualitative methodology. Individual interviews were conducted with people with T2DM using insulin who were purposively sampled from the Diabetes and Primary Care Clinics, University Malaya Medical Centre, Malaysia in 2013. All participants had hyperglycemia (HbA1c ≥ 9% for > 1 year) despite insulin-use. An interview guide was used for the interviews. The interviews were audio-recorded, transcribed verbatim and analyzed using a thematic approach. Seventeen participants whose age ranged from 22-69 years were recruited. Their years living with diabetes ranged from 2-30 years while years using insulin ranged from 1-14 years. Data analysis uncovered four themes. First is the lifestyle challenges in adhering to medical recommendations. Participants faced difficulties in integrating diabetes self-care tasks into daily work-life schedule. They also could not resist food cravings and health-limiting conditions hampered their exercise performance; these contributed to the poor glycaemic control. Secondly, psychosocial and emotional problems caused participants to neglect their diabetes self-care. Some gave up when there was no improvement in glycaemic control. Thirdly, side effects of insulin such as fear of hypoglycaemia and increased hunger caused participants to overeat and omit insulin. The final theme is the lack of awareness and self-efficacy in diabetes self-care. Lack of awareness of glycaemic levels and targets rendered participants unsure to what extent they should control their diet. Some were not confident in iv adjusting their insulin dosage for fear of adverse consequences. This study identified patients’ lifestyle factors, psychosocial issues, concerns about insulin side effects and lack of self-efficacy as the main factors that contribute to poor glycaemic control. These factors must be considered by healthcare providers when assessing poor glycaemic control in people with T2DM using insulin