The authors highlight that whilst insulin has been identified as the most effective glucose-lowering agent, it has been shown that many people with diabetes who are using insulin still fail to achieve glycaemic control.
Seventeen people with type 2 diabetes using insulin were interviewed for the study between January and August 2013. The analysis of the interviews uncovered four themes:
Lifestyle challenges in adhering to medical recommendations
- A difficulty integrating diabetes medical recommendations, such as medication regimen and meal times, into their daily activity and work–life schedule.
- An inability to control food cravings and eating habits.
- Inappropriate diet recommendations by HCPs – including feeling the recommended diet did not provide them with enough energy or the monotony of eating the same foods every day.
- Finding it difficult to exercise because of health-limiting conditions was also cited by many as a reason for poor glycaemic control.
Psychosocial issues and emotional hurdles
- Psychosocial problems such as anxiety and stress affected diabetes self-care management, for example through leading to the adoption of unhealthy eating patterns and not taking medication.
- A loss of motivation – participants admitted that they were so tired of adhering to diabetes medications after having taken them for such a long time that sometimes they would intentionally skip doses.
- A perception by older participants that whatever their attempts to control blood glucose levels, their glycaemic control would still fall short because of their advanced age.
Treatment related factors
- Side effects of insulin. Participants reported that they would tend to overeat to prevent or counter the effects of insulin-induced hypoglycaemia. Participants also felt that insulin caused them to feel hungry, causing them to overeat, hence, raising their blood sugar levels.
Lack of knowledge about and self-efficacy in diabetes care
- Lack of knowledge of their glycaemic level and target was also cited as a reason for poor glycaemic control, as participants were not aware to what extent they should control their blood sugar. Despite receiving advice from the doctor that they could adjust their insulin dosage, some participants did not do so because they were afraid of making mistakes.
The full study can be read here.
BMJ Open 2015;5:e006407 doi:10.1136/bmjopen-2014-006407
Why do some people with type 2 diabetes who are using insulin have poor glycaemic control? A qualitative study
Wen Ting Tong, Shireene Ratna Vethakkan, Chirk Jenn Ng