Attitudes and barriers to insulin therapy: Is there a difference between developed countries and developing countries?

Introduction: Trinidad is a small island middle income country with a high prevalence of type 2 Diabetes. As much as 60% of patients are likely to need insulin therapy in the future. The first step in preparing a patient to convert to insulin therapy is to determine barriers to insulin therapy. The aim of this study is determine barriers to initiating insulin therapy in a primary care setting in Trinidad, to inform appropriate intervention towards effective conversion. Methods: A structured pretested questionnaire was designed to collect demographic data, which included age, gender and highest level of education attained as well as knowledge and beliefs about insulin therapy among patients on oral hypoglycaemic agents only. In addition we compared these findings with a group of patients on insulin. Results: Knowledge of insulin was high (98%) yet the majority of patients (64.2%) were unaware they may require insulin in the future. Key barriers to initiating insulin treatment were, fear of needles, pain and apprehension about injecting oneself were prominent among respondents (85, 53.5%). The largest barrier to insulin therapy (54.1%) was anxiety about mastering the skill of giving oneself an injection, the general hassle of taking injections, concern about preparing the correct dose of insulin, and apprehension about the proper technique of needle injection. Conclusion: This research the first of its kind to be undertaken in this setting identified the most important common beliefs of insulin-naïve patients who may need to initiate insulin therapy in the future. In addition it provides evidence to guide diabetes educators and other health care professionals to use in educating patients.