Insulin perception among insulin-naïve type-2 diabetes mellitus patients in Pakistan

Figures & data

Table 1. Patient characteristics (N = 160)

Variables	N	%
Age (years)
<30	2	1.3
31–40	26	16.3
41–50	70	43.8
51–60	43	26.9
>60	19	11.9
Gender
Female	103	64.4
Male	57	35.6
Residence
Rural	64	40
Urban	96	60
Occupation
Business	8	5
Government job	32	20
Private job	24	15
Labor	16	10
No job/retired	80	50
Education
Illiterate	32	20
Religious	16	10
Primary	24	15
Secondary	48	30
Tertiary	40	25
Income (PKR)
<5,000	16	10
5,001–10,000	24	15
10,001–15,000	40	25
15,001–20,000	32	20
>20,000	48	30
Willingness to use insulin
Yes	56	35
No	104	65
Duration of diabetes (years)
Mean (SD)	6.9	(±3.246)
Recent HbA1C (%)
Mean (SD)	8.62	(±0.481)

Notes: Income is mentioned in Pakistani Rupees (1 PKR = 0.0095 USD). The USD rate is based on the international currency conversion rate as that of 2 February 2016.

Table 2. Response of T2DM patients to Insulin Perception Questionnaire

No.	Insulin Perception Questionnaire	Response N (%)
		SD	D	DK	A	SA
1	Insulin will help me in controlling diabetes	4 (2.5)	15 (9.4)	7 (4.4)	59 (36.9)	75 (46.9)
2	Insulin will improve my health status	5 (3.1)	21 (13.1)	17 (10.6)	39 (24.4)	78 (48.8)
3	Insulin will make me less diet restrictive	16 (10.0)	32 (20.0)	8 (5.0)	56 (35.0)	48 (30.0)
4	Insulin usage will show that my diabetes has worsened	5 (3.1)	26 (16.3)	9 (5.6)	40 (25.0)	80 (50.0)
5	Insulin usage will show that I failed to take care myself	13 (8.1)	14 (8.8)	16 (10.0)	40 (25.0)	77 (48.1)
6	Insulin once started, can’t be stopped	14 (8.8)	13 (8.1)	9 (5.6)	8 (5.0)	116 (72.5)
7	Insulin usage will make my travel and eat out difficult	16 (10.0)	16 (10.0)	8 (5.0)	40 (25.0)	80 (50.0)
8	Insulin usage will cause complications in later life	14 (8.8)	16 (10.0)	24 (15.0)	16 (10.0)	90 (56.3)
9	Insulin usage will increase the risk of hypoglycemia	14 (8.8)	16 (10.0)	38 (23.8)	40 (25.0)	52 (32.5)
10	Insulin usage will increase my weight	7 (4.4)	9 (5.6)	8 (5.0)	24 (15.0)	112 (70.0)
11	Insulin usage will make me blind	40 (25.0)	40 (25.0)	16 (10.0)	24 (15.0)	40 (25.0)
12	Insulin usage will increase the risk of heart diseases	8 (5.0)	32 (20.0)	64 (40.0)	32 (20.0)	24 (15.0)
13	Insulin usage will badly affect my body shape	7 (4.4)	16 (10.0)	7 (4.4)	40 (25.0)	90 (56.3)
14	Insulin is too expensive	19 (11.9)	14 (8.8)	46 (28.8)	16 (10.0)	65 (40.6)
15	Insulin is obtained from haram sources	8 (5.0)	32 (20.0)	46 (28.8)	14 (8.8)	60 (37.5)
16	I believe I can’t measure the correct dose of insulin	8 (5.0)	40 (25.0)	8 (5.0)	56 (35.0)	48 (30.0)
17	I believe I can’t inject insulin correctly	8 (5.0)	34 (21.3)	14 (8.8)	40 (25.0)	64 (40.0)
18	I am afraid of needle injections	25 (15.6)	32 (20.0)	16 (10.0)	15 (9.4)	72 (45.0)
19	If I used Insulin, people will treat me differently	35 (21.9)	32 (20.0)	21 (13.1)	8 (5.0)	64 (40.0)
20	Insulin usage will make me feel embarrassed in front of people	31 (19.4)	22 (13.8)	21 (13.1)	22 (13.8)	64 (40.0)

Notes: Likert scale: SD = strongly disagree, D = disagree, DK = don’t know, A = agree, SA = strongly agree.

Table 3. Association of insulin perception with T2DM patient characteristics

Variables	Mean	SD	Mean rank	p-value
Age^a
<30	45.00	18.39	65.75	<0.001
31–40	44.65	10.72	53.77
41–50	51.03	10.19	81.66
51–60	52.89	9.07	89.85
>60	53.19	11.11	93.18
Gender^b
Female	46.89	7.05	63.47	<0.001
Male	57.63	12.76	111.27
Residence^b
Rural	47.55	11.4	62.72	<0.001
Urban	52.83	9.82	92.35
Occupation^a
Business	56.38	1.3	113.06	<0.001
Government Job	61.91	10.49	122.19
Private Job	51.63	9.67	83.19
No Job/Retired	48.69	2.75	69.38
Labor	45.81	9.05	61.99
Education^a
Illiterate	40.34	9.21	32.22	<0.001
Religious	40.94	4.15	38.73
Primary	52.73	7.28	91.26
Secondary	56.83	5.58	101.13
Tertiary	56.85	11.05	112.48
Income^a
<5,000	38.5	7.86	28.06	<0.001
5,001–10,000	41.63	8.37	41.77
10,001–15,000	51.83	10.24	85.55
15,001–20,000	55.69	7.83	103.23
>20,000	55.1	8.95	97.98
Willingness to use insulin^b
Yes	54	9.4	94.48	<0.001
No	44.63	10.56	54.54

Notes: The minimum possible score was 0 and maximum was 100.

The income is mentioned in Pakistani Rupees (1 PKR = 0.0095 USD).

The USD rate is based on the international currency conversion rate as that of 2 February 2016.

^a Kruskal-Wallis test.

^b Mann-Whitney test.

Figure 1. Perception of insulin in T2DM patients.

Notes: All of the patients who scored <66% scores were categorized as patients with negative perception, and those scoring ≥66% were categorized as patients with positive perception. Overall, the minimum achievable score was 1 and maximum was 100.

Table 4. Factors affecting the perception score of diabetes patients

Variables	Regression coefficient (β) [95% CI]	t	Std. error	p-value
Age	0.075 [−0.451–2.191]	1.301	0.669	0.195
Gender	0.559 [8.691–16.378]	6.443	1.945	<0.001
Residence	−0.109 [−5.517–0.754]	−1.501	1.587	0.136
Occupation	0.055 [−1.268–2.367]	0.597	0.920	0.551
Education	0.366 [−0.835–4.577]	2.858	0.947	0.005
Income	0.238 [0.071–3.785]	2.051	0.940	0.042
Willingness to use insulin	0.060 [−2.306–5.011]	0.730	1.852	0.466

Notes: Linear regression was applied using score as a dependent variable and the age, gender, residence, occupation, education, income and willingness to use insulin as independent variables. A p < 0.05 was considered significant.