JPMI VOL. 33 NO. 1 VOL. 33 NO. 1 13 13 PSYCHOLOGICAL BARRIERS TOWARDS EARLY INSULIN INITIA- TION IN UNCONTROLLED TYPE 2 DIABETIC PATIENTS Naveed Iqbal 1 , Zafar Ali 2 , Inayat Ullah 3 , Ziauddin 4 , Muhammad Bilal Awan 5 , Khalid Mahmood 6 ORIGINAL ARTICLE INTRODUCTION Diabetes is a progressive disease and its manage- ment is complicated with time as the beta cells are pro- gressively diminished. Oral hypoglycemic agents are then frequently not sufficient to control glycemic status and insulin therapy is required. It has been shown that more than half of the newly diagnosed diabetic patients are not able to achieve target HbA1c and require insulin therapy within 6 years of diagnosis 1,2 . Many landmark lineal and epidemiological studies have shown reduced incidence of microvascular and macrovascular compila- tions in intensively controlled diabetic patients 3˗5 . As poorly controlled type 2 diabetics are more prone to long term complications of diabetes mellitus, early use of insulin has been recommended to prevent long term complications of diabetes 6 . About fifty percent of diabetic patients with poorly controlled glycemic sta- tus do not start their insulin therapy timely and there is usually a delay of three to five years after failure of oral hypoglycemic agents 7,8 . A study carried out in USA showed that 33% of type 2 diabetics who were poorly controlled refuse to start insulin therapy 9 . Another study conducted in Bangladesh showed that 42.5% patients with poorly controlled type 2 diabetes were unwilling to start insulin therapy initially with 20.3% refusing in- sulin use even after repeated counselling 10 . Similarly, an Egyptian study reported insulin refusal in 40% of un- controlled diabetic patients 11 . There are many factors which influence delayed in- sulin initiation including those related to health system and health care providers as well as the patients them- selves 12,13 . One of the main barrier is psychological insu- lin resistance (PIR), defined as psychological opposition towards insulin use among patients as well as health care providers 12,14 . The clinician can play a vital role in the timely introduction of insulin and majority of PIR cases can be prevented through effective health educa- ABSTRACT Objective: To determine the frequency of patients’ related psychological fac- tors that delay timely insulin initiation in uncontrolled type 2 diabetic patients presenting to a teaching hospital. Methodology: This was a descriptive study performed in Lady Reading Hos- pital, Medical Teaching Institution, Peshawar from February 2017 to February 2018. Three hundred patients of type 2 Diabetes who had not achieved target HbA1c were enrolled in the study by simple random sampling. A questionnaire was filled for each patient, after consent, including their age, sex and occupa- tion, duration of diabetes, HbA1c level, current medications and reasons for insulin refusal. SPSS version 20 was used for data interpretation. Results: Three hundred patients [168 (54%) female and 132 (46%) male] were included in the study. Requirement of healthcare personnel to inject insulin (91.33%) followed by fear of injection (85.33%), fear of hypoglycemia (84%), insulin therapy being lifelong (84%) and injections being painful (80.66%) were the most reported concerns. Insulin injections being embarrassing (41.33%), vi- sion problem (42.66%) and fear of weight gain (44.66%) were the least reported concerns of the patients. Conclusion: A number of important psychological barriers leading to refusal of early insulin initiation in uncontrolled type 2 diabetic patients were found in this study. Requirement of healthcare personnel to inject insulin was found to be the most frequent psychological barrier followed by fear of injection, fear of hypoglycemia, lifelong insulin therapy and injections being painful. Key Words: Type 2 diabetes, Insulin, Psychological barriers, Hypoglycemia 1-6 Department of Medi- cine, Lady Reading Hospital, Medical Teaching Institution, Peshawar – Pakistan. Address for Correspondence: Dr. Zafar Ali Assistant Professor, Department of Medicine, Lady Reading Hospital, Medical Teaching Institution, Peshawar - Pakistan. Email: ali_zafar1973@yahoo. com Date Received: September 21, 2018 Date Revised: January 24, 2019 Date Accepted: January 31, 2019 This article may be cited as: Iqbal N, Ali Z, Ullah I, Ziauddin, Awan MB, Mahmood K. Psychological barriers towards early insulin initiation in uncontrolled type 2 diabetic patients. J Postgrad Med Inst 2019; 33(1): 13-8.