title: Factors influencing insulin usage among type 2 diabetes mellitus patients: A study in Turkish primary care.
abstract: BACKGROUND
  DM (diabetes mellitus) patients with poorly regulated blood glucose levels are at risk of increased morbidity and mortality. There are different factors that cause resistance to the initiation of insulin therapy such as beliefs and perceptions concerning diabetes and its treatment and the nature and consequences of insulin therapy.
  
  
  OBJECTIVE
  We aimed to explore the reasons for this reluctance and how these obstacles could be overcome so that DM patients who require insulin could initiate therapy.
  
  
  METHODS
  This was a cross-sectional, descriptive study of diabetic patients with glycated haemoglobin A1c(HbA1C) levels above 7.0%, who were followed-up at a primary care and endocrinology outpatient clinic.
  
  
  RESULTS
  Ninety-four patients (57.4% females, 42.6% males) were recruited for this study. Most patients (57.4%) considered that insulin was a drug of last resort. Among all patients, 34.1% thought that insulin lowered blood glucose levels to an extreme degree and 14.9% disagreed. The patients thought that self-injection was hard (27.6%), required someone else to administer the injection (27.6%), insulin injection was painful (33.0%). 59.6% of all patients believed that their religion did not restrict the use of insulin, 52.1% stated that their family physicians had sufficiently informed them.
  
  
  CONCLUSIONS
  Our most significant finding is that a lack of adequate information relating to insulin appears to be the major factor behind DM patients' refusal of insulin treatment. The fact that patients consider insulin treatment as a final solution to DM could be related to resistance to the initiation of insulin therapy. [Box: see text].
authors.affiliation: a Department of Family Physicians , Dicle University Medical Faculty , Diyarbakir , Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Yilmaz
authors.affiliation: b Department of Family Physicians , Zirve University Medical Faculty , Gaziantep , Turkey.
authors.forename: Muharrem
authors.initials: M
authors.lastname: Ak
authors.affiliation: c Department of Medical Genetics , Dicle University Medical Faculty , Diyarbakir , Turkey.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Cim
authors.affiliation: d Department of Public Health , Dicle University Medical Faculty , Diyarbakir , Turkey.
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Palanci
authors.affiliation: e Department of Endocrinology , Dicle University Medical Faculty , Diyarbakir , Turkey.
authors.forename: Faruk
authors.initials: F
authors.lastname: Kilinc
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards; D011320:Primary Health Care; D016312:Treatment Refusal; D014421:Turkey
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Family physician; educational status; insulin resistance; religion