Barriers to self-injection of insulin among patients attending the diabetes clinics at the three referral hospitals in Bhutan: a cross-sectional study

Introduction: Insulin, despite its increasing cost, is prescribed to selected cases of diabetes patients with an aim to achieve good glycaemic control. However, many on insulin do not achieve glycaemic control. We, therefore, studied the possible factors that may act as barriers to effective self-injection of insulin among diabetes patients at the three referral hospitals in Bhutan. Methods: This was a cross-sectional study, conducted from January-June 2017, involving all patients on insulin therapy for more than three months duration. Convenience sampling was used. Respondents’ basic details and self-reported barriers to insulin therapy under various domains were collected using an interviewer-administered questionnaire. Ethics approval was granted by the Research Ethics Board of Health, Bhutan. Results: There were 207 respondents on insulin therapy. The mean age of the sample was 55 years (±13.8 years) and the mean duration of diabetes was 10.6 years (± 7.8 years). Injection dexterity was an issue in 77 respondents (37.2%) while 37 respondents (17.8%) reported that they would miss their insulin shots if their caregiver were unavailable. Insulin regimens were burdensome and interfered with their daily activities (80; 38.7%) and meal timings (64; 30.9%). Although the majority (179; 86.4%) knew why insulin was indicated for them, 149 (72.0%) found that the healthcare personnel’s demonstration on the use of insulin was inadequate and 50 respondents (24.2%) felt that they did not receive enough information on how to inject insulin. Conclusions: Barriers to self-injection are common among insulin users and coordinated efforts are needed to overcome them.