Background: Insulin therapy is the most effective treatment to achieve optimal glycemic control in patients with type 2 diabetes (T2DM), while insulin adherence is crucial to achieve optimal glycemic control in insulin-treated patients. Understanding factors associated with insulin adherence in patients initiating insulin therapy will help to improve long-term insulin adherence.

Method: This study was a 3-month prospective study. One hundred and twenty-six (63 males and 63 females) patients with T2DM who were initiating insulin therapy were recruited. At baseline, when patients accepted receiving insulin therapy, demographic data (age, sex, duration of diabetes), psychosocial factors (health literacy, diabetes distress, quality of life, perceived benefits of insulin therapy, and perceived barriers of insulin therapy) were measured by self-reported questionnaires. Clinical data (HbA1c levels, body mass index) were collected from medical records. Adherence to insulin injection was measured by the 8-item Moriskey Medication Adherence Scale (MMAS) after 3 months of initiating insulin therapy. Higher score MMAS indicated poorer insulin adherence.

Results: The mean age of participants was 59.11 years (SD: 13.30). Baseline diabetes distress (r=0.202, p=0.024), quality of life(r=-0.227, p=0.010), and perceived benefit of insulin therapy (r=-0.189, p=0.035) significantly correlated with 3-month insulin adherence. Age, sex, baseline HbA1c levels, duration of diabetes, body mass index, health literacy, and perceived barriers of insulin injection did not significantly associate with insulin adherence.

Conclusion: Baseline psychosocial factors rather than demographic data and clinical data are associated with insulin adherence 3 months later. To improve insulin adherence, healthcare providers should address the diabetes distress, QoL, and perceived benefit of insulin therapy when educating patients initiating insulin therapy.


S. Ma: None. R.H. Wang: None. C. Lee: None. H. Hsu: None. T. Lee: None. S. Chen: None.

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