title: Perceptions of insulin therapy amongst Asian patients with diabetes in Singapore.
abstract: OBJECTIVE
  The objective of this study was to determine the prevalence of insulin refusal amongst Singaporean patients with Type 2 diabetes mellitus, to compare perceptions regarding insulin therapy use between patients who were willing to use insulin and those who were not and to identify demographic factors that might predict insulin refusal.
  
  
  METHODS
  A cross-sectional interviewer-administered survey incorporating demographic variables and 17 perceptions regarding insulin use (14 negative and three positive) was conducted among a sample of 265 patients attending a public primary healthcare centre.
  
  
  RESULTS
  Seven of every 10 patients expressed unwillingness to use insulin therapy (70.6%). The greatest differences in perceptions between patients willing to use insulin therapy and those who were not included fear of not being able to inject insulin correctly (47.4 vs. 70.6%), fear of pain (44.9 vs. 65.8%), belief that insulin therapy would make it difficult to fulfil responsibilities at work and home (46.2 vs. 66.8%) and belief that insulin therapy improved diabetes control (82.1 vs. 58.3%). A tertiary level of education was associated with willingness to use insulin (odds ratio 3.3, confidence interval 1.8-6.1), and significant differences in perceptions were present in patients with different educational levels.
  
  
  CONCLUSIONS
  Insulin refusal is an important problem amongst our patients with Type 2 diabetes mellitus. Findings of this study suggest that interventions aimed at increasing insulin therapy use should focus on injection-related concerns, perceived lifestyle adaptations and correction of misconceptions. Different interventions may also be required for patients of different educational groups.
authors.affiliation: Bukit Batok Polyclinic, National Healthcare Group Polyclinics, 50 Bukit Batok West Avenue 3, Singapore. sabwongkw@gmail.com
authors.forename: S
authors.initials: S
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.forename: Y
authors.initials: Y
authors.lastname: Ko
authors.forename: M F
authors.initials: MF
authors.lastname: Chong
authors.forename: C K
authors.initials: CK
authors.lastname: Lam
authors.forename: W E
authors.initials: WE
authors.lastname: Tang
mesh_terms: D044466:Asian People / Q000523:psychology*; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D015995:Prevalence; D012646:Self Administration / Q000523:psychology*; D012846:Singapore / Q000208:ethnology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin