Factors Affecting the Compliance with Insulin Use in Diabetic Patients

1. Institute of Pharmaceutical Sciences, UVAS Lahore Factors Affecting the Compliance with Insulin Use in Diabetic Patients of Tertiary Care Hospital of Lahore By: MoazzamRiaz (Pharm-D) Supervisor: Malik Allah Bukhsh

2. Research Purposes • To identify the problem regarding health care. • Awareness about the problem for solution. • Quantitative record of problem magnitude. • To recommend effective strategies for implementingclinicalpractice guidelines . • To evaluate health care outcomes.

3. AIMS & OBJECTIVES • To evaluate compliance of patients with insulin use • Factors affecting the compliance of insulin • Who guide the patients of diabetes about administration of insulin, counseled them about the insulin use and disease management

4. METHODOLOGY Study Design Prospective, Concurrent Observational Study Study Area tertiary care Hospitals of Lahore Study DurationSeptember –November 2013 Sample Size100 patients Data SourceOPD patients interview Inclusion Criteria All the outpatients Males and females Children, adults and geriatrics with diabetes mellitus Exclusion Criteria Inpatients Pregnant women and lactating women Statistical DesignSPSS version 16 Descriptive statistics

5. PARAMETERS TO BE EVALUATED • Gender Distribution • Patients can inject insulin by themselves • Patients know about proper storage of insulin • Patients know about proper insulin administration technique • Patients were serious about their disease Management • Patients were facing social criticism with insulin use • Patients have gluco-meter and knew about strips storage • Patients were feeling fear of addiction • Who guide them about insulin use

7. RESULTS %age of male and female patients

8. RESULTS %age of patients from different tertiary care hospitals of Lahore

9. 42 % 58%

10. 3% 97 %

11. 40% 60 %

13. 48 % 52 %

14. RESULTS %age of health care professionals who guide the patients

15. CONCLUSION • Diabetic patients revealed that their information on insulin use was poor. • Their insulin injecting skills were amateur. • The patients face problems while searching for information from health care professionals. • They face difficulties in understanding the guidance on insulin therapy • These patients were interested in improving their information regarding insulin use by involving the health care professionals

16. RECOMMENDATIONS • The hospitals should have diabetic centers with a pharmacist over there and it should have clear objectives which are in lined with the problems faced by the patients in insulin use. • There should be collaboration between pharmacist and physician because the patient communicate directly with these two stakeholders of the health. • The pharmacist should have good communication skills in order to deliver the instructions to the patients. • Campaigns on instructions of insulin use should be organized time to time in the hospitals and at community level in order to facilitate the patients and to increase the adherence with the therapy.

17. RECOMMENDATIONS • Follow up sessions should be organized at the hospitals to check whether these patients are complying with treatment or not. • Insulin should be made available to the patients especially at government hospitals. • The patients should be instructed how to use gluco-meter to check their glucose level in blood. • Social support should be provided to the patients for insulin therapy and they should not be criticized over their treatment.

18. STRATEGIES • Counseling of diabetic Patients at MAYO, JINNAH and GENERAL hospital • To develop pictogram showing insulin administration technique • To Publish our research in journal • To Develop a booklet about counseling guidelines

29. REFERENCES • 1-Lee W.C, Bali S, Cobden D, Joshi A. V, Pashos A. S. Medication Adherence and the Associated Health-Economic Impact Among Patients with Type 2 Diabetes Mellitus Converting to Insulin Pen Therapy: An Analysis of Third-Party Managed Care Claims Data. Clinical Therapeutics 2006; 28:1-14 • 2-Morris a. D, Boyle D. I. R, McMahon A. D, Greene S. A, McDonald T. M, Newton R. W, Adherence to insulin treatment, glycemic control, and ketoacidosis in insulin-dependent diabetes mellitus. The Lancet 1997 ; 350: 1505-10. • 3-Krass I, Delaney C, Glaubitz S, Kanjanarach T. Measuring patient satisfaction with diabetes disease state management services in community pharmacy. Research In Social And Administrative sciences 2009; 5: 13-39. • 4-Wens J, Vermeir E, Hearnshaw H, Lindenmeyer A, Biot Y, Royen V. P. Educational interventions aiming at improving adherence to treatment recommendations in type 2 diabetes A sub-analysis of a systematic review of randomized controlled trials. Diabetes Research And Clinical Practice 2008; 39:377-388. • 5-Lerman I. Adherence to Treatment: The Key for Avoiding Long-Term Complications of Diabetes. Archives of Medical Research 2005; 36:1-7.

30. REFERENCES • 06-Amir A. H. Non-comliance With The Use Of Insulin Amongst Insulin Requiring Diabetics: Causes And Its Possible Solutions. JPMI vol.17(2). • 07-Cramer J. A. Systematic Review of Adherence With Medications for Diabetes. Diabetes Care 2004;27: 1218-1224. •  08-Siminerio L, Kulkarni K, Meece J, Williams A, Cypress M, Haas L ,Pearson T,Rodbard H, Lavernia F. Strategies for Insulin Injection Therapy in Diabetes Self-Management. American Association of Diabetes Educators 2011 • .09-Yach D.ADHERENCE TO LONG TERM THERAPIES: Evidence for action. WHO 2003:110 pages [E]. •  10- Guidelines for Insulin Initiation and Adjustment in Primary Care in patients with Type 2 Diabetes: for the guidance of Diabetes Specialist Nurses: Glasgow Diabetes Managed Clinical Network. •  11- AMERICAN DIABETES ASSOCIATION. Insulin Administration. Diabetes Care 2004; vol. 27. •  12-.Loghmani E,Diabetes Mellitus: Type 1 And Type2.Guidlines for Adolescent nutrition Services. •  13AMERICAN DIABETES ASSOCIATION. Standards of Medical Care in Diabetes-2013. Diabetes Care 2013; vol. 36.

31. Future strategies • To Evaluate Patient Awareness after their counseling about Disease • To evaluate Compliance of patients with insulin use • To assess Patient Knowledge about Importance of insulin in Diabetes Mellitus • Continuation of counseling services in Tertiary care Hospitals of lahore

32. Any Question ??