Deveplopment and validation of insulin adherence questionnaire (IAQDM) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus

Introduction: Prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide and locally. Although various treatments were prescribed to control blood glucose level, the glycaemic target is still not achieved. At present, insulin therapy becomes the mainstay of treatment because of its effect...

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Main Author:	Singh @ Nui, Shareen A/P Purran
Format:	Thesis
Language:	English
Published:	2016
Subjects:	RC648-665 Diseases of the endocrine glands Clinical endocrinology
Online Access:	http://eprints.usm.my/44047/1/Dr.%20Shareen%20ap%20Purran%20Singh%40Nui-24%20pages.pdf
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spelling	my-usm-ep.440472019-04-12T05:25:32Z Deveplopment and validation of insulin adherence questionnaire (IAQDM) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus 2016 Singh @ Nui, Shareen A/P Purran RC648-665 Diseases of the endocrine glands. Clinical endocrinology Introduction: Prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide and locally. Although various treatments were prescribed to control blood glucose level, the glycaemic target is still not achieved. At present, insulin therapy becomes the mainstay of treatment because of its effectiveness to control blood glucose. However, insulin injection is complex and can contribute to non-adherence problem among insulin treated patients with diabetes. Objective: To develop and validate a new questionnaire to measure adherence with insulin therapy in patients with T2DM. This study also aimed to determine rate of non-adherence, glycaemic control and factors associated with insulin therapy. Methodology: This study used qualitative design in the initial part of the study to choose appropriate themes for the IAQDM and quantitative design was utilised for the rest of the study. Interviews were conducted among 30 patients with T2DM on insulin therapy using developed and validated semi-structured interview guide. Items for the new IAQDM were selected from patients’ interviews, literature reviews, and consultation with the experts. The IAQDM was validated among 156 patients with T2DM on insulin therapy at the Diabetic Centre, Hospital Universiti Sains Malaysia,Kubang Kerian, Kelantan, Malaysia. Rate of insulin non-adherence, glycaemic control and factors associated with insulin non-adherence were measured in 355 patients with type 2 diabetes mellitus. Transcript data from the initial interviews were analysed for relevant themes using NVivo software version 10.0. Data for sociodemography, insulin non-adherence rate, glecemic control and factors associated with insulin therapy were analysed quantitatively using Statistical Package of Social Science (SPSS) version 22. Result: The IAQDM consisted of 35 items and four domains: domain 1 (barriers with insulin injection), domain 2 (self-monitoring of insulin and blood glucose), domain 3 (adherence with insulin injection) and domain 4 (dietary adjustment with insulin therapy). Overall Cronbach’s alpha value for all the 35 items in the IAQDM was 0.82. Cronbach’s alpha values for each domain are 0.82, 0.88, 0.85 and 0.82 respectively. Non-adherence rate with insulin therapy among patients with type 2 diabetes was 81%. Majority (98%) of patients on insulin therapy did not achieve the target HbA1c of < 6.5%. Duration of insulin therapy, frequency of insulin injections and fasting plasma glucose were identified as independent and significant factors to non-adherence with insulin therapy. Conclusion: A new IAQDM with very good psychometric properties to measure adherence with insulin therapy has been developed. Adherence with insulin therapy and glycemic control among patients with T2DM were very poor. Identification of several factors contributed to insulin non-adherence can provide a very useful guide for screening, managing, monitoring, and improving adherence with insulin therapy. 2016 Thesis http://eprints.usm.my/44047/ http://eprints.usm.my/44047/1/Dr.%20Shareen%20ap%20Purran%20Singh%40Nui-24%20pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RC648-665 Diseases of the endocrine glands Clinical endocrinology
spellingShingle	RC648-665 Diseases of the endocrine glands Clinical endocrinology Singh @ Nui, Shareen A/P Purran Deveplopment and validation of insulin adherence questionnaire (IAQDM) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus
description	Introduction: Prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide and locally. Although various treatments were prescribed to control blood glucose level, the glycaemic target is still not achieved. At present, insulin therapy becomes the mainstay of treatment because of its effectiveness to control blood glucose. However, insulin injection is complex and can contribute to non-adherence problem among insulin treated patients with diabetes. Objective: To develop and validate a new questionnaire to measure adherence with insulin therapy in patients with T2DM. This study also aimed to determine rate of non-adherence, glycaemic control and factors associated with insulin therapy. Methodology: This study used qualitative design in the initial part of the study to choose appropriate themes for the IAQDM and quantitative design was utilised for the rest of the study. Interviews were conducted among 30 patients with T2DM on insulin therapy using developed and validated semi-structured interview guide. Items for the new IAQDM were selected from patients’ interviews, literature reviews, and consultation with the experts. The IAQDM was validated among 156 patients with T2DM on insulin therapy at the Diabetic Centre, Hospital Universiti Sains Malaysia,Kubang Kerian, Kelantan, Malaysia. Rate of insulin non-adherence, glycaemic control and factors associated with insulin non-adherence were measured in 355 patients with type 2 diabetes mellitus. Transcript data from the initial interviews were analysed for relevant themes using NVivo software version 10.0. Data for sociodemography, insulin non-adherence rate, glecemic control and factors associated with insulin therapy were analysed quantitatively using Statistical Package of Social Science (SPSS) version 22. Result: The IAQDM consisted of 35 items and four domains: domain 1 (barriers with insulin injection), domain 2 (self-monitoring of insulin and blood glucose), domain 3 (adherence with insulin injection) and domain 4 (dietary adjustment with insulin therapy). Overall Cronbach’s alpha value for all the 35 items in the IAQDM was 0.82. Cronbach’s alpha values for each domain are 0.82, 0.88, 0.85 and 0.82 respectively. Non-adherence rate with insulin therapy among patients with type 2 diabetes was 81%. Majority (98%) of patients on insulin therapy did not achieve the target HbA1c of < 6.5%. Duration of insulin therapy, frequency of insulin injections and fasting plasma glucose were identified as independent and significant factors to non-adherence with insulin therapy. Conclusion: A new IAQDM with very good psychometric properties to measure adherence with insulin therapy has been developed. Adherence with insulin therapy and glycemic control among patients with T2DM were very poor. Identification of several factors contributed to insulin non-adherence can provide a very useful guide for screening, managing, monitoring, and improving adherence with insulin therapy.
format	Thesis
qualification_level	Master's degree
author	Singh @ Nui, Shareen A/P Purran
author_facet	Singh @ Nui, Shareen A/P Purran
author_sort	Singh @ Nui, Shareen A/P Purran
title	Deveplopment and validation of insulin adherence questionnaire (IAQDM) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus
title_short	Deveplopment and validation of insulin adherence questionnaire (IAQDM) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus
title_full	Deveplopment and validation of insulin adherence questionnaire (IAQDM) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus
title_fullStr	Deveplopment and validation of insulin adherence questionnaire (IAQDM) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus
title_full_unstemmed	Deveplopment and validation of insulin adherence questionnaire (IAQDM) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus
title_sort	deveplopment and validation of insulin adherence questionnaire (iaqdm) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2016
url	http://eprints.usm.my/44047/1/Dr.%20Shareen%20ap%20Purran%20Singh%40Nui-24%20pages.pdf
_version_	1747821325053853696

Deveplopment and validation of insulin adherence questionnaire (IAQDM) and determination of factors associated with non-adherence among patients with type 2 diabetes mellitus

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