Uncovering the Predictors of Nonadherence to Insulin Therapy Among Patients With Type 1 and Type 2 Diabetes Attending an Endocrinology Outpatient Clinic of a Tertiary Care Hospital

TL;DR

This study found that over a third of diabetes patients at a hospital in India do not properly follow their insulin therapy, with factors like poor storage and complex regimens being key issues.

Contribution

The study identifies specific predictors of insulin nonadherence in a tertiary care setting in India, offering actionable insights for improving adherence.

Findings

36.8% of patients were nonadherent to insulin therapy.

Lack of insulin storage and type 2 diabetes were strong predictors of nonadherence.

Primary education was associated with better adherence.

Abstract

Nonadherence to insulin therapy remains a major challenge to achieving optimal glycemic control, leading to complications and increased health care costs. Despite accessible insulin therapy in tertiary hospitals, barriers such as injection fear, complex regimens, inadequate storage, stigma, and limited health literacy contribute to poor adherence. Evidence on determinants of insulin nonadherence in tertiary care settings in India remains limited. This study aimed to determine the prevalence and predictors of insulin nonadherence among adults with diabetes mellitus.

A cross-sectional survey was conducted from February to July 2025 among adults (≥18 years) with type 1 or type 2 diabetes mellitus receiving insulin therapy for at least 6 months, selected using a consecutive sampling technique. The 8-item Morisky Medication Adherence Scale assessed adherence; scores <6 indicated nonadherence. Data were analyzed using SPSS version 29, and binary logistic regression identified independent predictors.

Of 402 participants, 36.8% were nonadherent. Independent predictors of nonadherence included upper-middle socioeconomic status (adjusted odds ratio [AOR] 2.11; 95% CI 1.07–4.15; P = 0.031), type 2 diabetes (AOR 2.23; 95% CI 1.20–4.14; P = 0.011), lack of insulin storage (AOR 4.72; 95% CI 2.28–9.76; P < 0.001), polypharmacy (AOR 4.00; 95% CI 0.99–16.14; P = 0.046), and poor lifestyle adherence (AOR 1.62; 95% CI 0.95–2.77; P = 0.047). Primary education was associated with lower odds of nonadherence (AOR 0.26; 95% CI 0.08–0.83; P = 0.023).

Over one-third of patients were nonadherent to insulin therapy. Findings highlight the need for focused educational support, behavioral counseling, and structural solutions such as improved storage provisions to enhance adherence and metabolic outcomes.

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