Insulin therapy refusal among type II diabetes mellitus patients in Kubang Pasu district, Kedah, Malaysia

224 1Clinical Research Centre of Kedah, 2Air Hitam Health Clinic, 3Tunjang Health Clinic, Kedah, Malaysia Correspondence: Dr Tan Wei Leong, Medical Officer, Clinical Research Centre, Sultanah Bahiyah Hospital, KM 6, Jalan Langgar, 05460, Alor Setar, Kedah, Malaysia. [email protected] INTRODUCTION The prevalence of diabetes mellitus in Malaysia has been increasing. According to the 2011 National Health and Morbidity Survey, the prevalence of diabetes mellitus in individuals aged ≥ 18 years had increased from 11.6% in 2006 to 15.2% in 2011.(1) In a keynote address by the Malaysian Director General of Health in 2012, the prevalence of diabetes mellitus was projected to increase by more than 20% in 2020.(2) The Diabetes Clinical Audit (2009–2011) from the National Diabetes Registry of Malaysia reported that in 2011, 17.1% of patients with diabetes mellitus were on insulin, while 13.4% were on oral hypoglycaemic agents and insulin.(3) With the increasing prevalence of diabetes mellitus in Malaysia, one of the main challenges in managing diabetic patients who have suboptimal control will be insulin therapy refusal. Although insulin therapy has been demonstrated to be efficacious, its initiation is often delayed in Malaysia. A study conducted by NurAzmiah et al in Kuala Lumpur and Putrajaya, two of the three federal territories of Malaysia, revealed that the reasons for psychological insulin resistance included personal failure, pain associated with insulin injection and fear of problematic hypoglycaemia.(4) The commencement of insulin therapy has always been a mutual decision between the healthcare provider and the patient. The decision-making process is affected by factors that involve both parties. Therefore, the aim of the present study was to determine the prevalence of insulin therapy refusal (from the patient’s perspective), as well as to identify the factors associated with insulin therapy refusal. As compared to the study cohort in NurAzmiah et al’s study,(4) our study population consists of patients from a rural area. These patients would have perceptions about healthcare and behaviours that are distinct from those living in the federal territories. Most of the previous studies from Malaysia and Singapore involved patient populations that consisted of well-urbanised city dwellers.(4,5)