FACTORS INFLUENCING USAGE OF INSULIN IN TYPE 2 DIABETES MELLITUS PATIENTS OF TERTIARY CARE TEACHING HOSPITAL OF GUJARAT

Introduction: Type 2 diabetes mellitus (T2DM) is a rapidly increasing public health problem in India, with many patients eventually requiring insulin therapy due to progressive β-cell dysfunction. Despite strong evidence supporting insulin’s role in achieving glycaemic control and preventing complications, initiation of insulin is frequently delayed because of psychological insulin resistance (PIR). This study aimed to assess knowledge, attitudes, and practices related to insulin therapy and to identify factors influencing insulin usage among patients with T2DM at a tertiary care teaching hospital in Gujarat. Methods: A cross-sectional observational study was conducted over three months (August–October 2023) at P.D.U. Medical College and Hospital, Rajkot, involving 100 adult patients with T2DM. Data were collected using a structured, validated questionnaire covering socio-demographic details, clinical characteristics, and knowledge, attitudes, and behavioural aspects related to insulin therapy. Descriptive statistics were used to analyse the data. Results: Among the 100 participants, 57 were receiving only oral hypoglycaemic agents and 43 were on insulin therapy for durations ranging from one month to ten years. While the majority of patients in both groups recognized that insulin prevents diabetic complications, misconceptions persisted regarding insulin being a last-resort therapy, lifelong dependency, dose escalation, hypoglycaemia, and weight gain. Patients not on insulin reported greater fear of injections, dependency on relatives, and lower trust in physicians when insulin treatment is advised, whereas cost concerns, preference for traditional Indian medicines, and apprehension toward frequent glucose monitoring were common across both groups. Discussion: The findings highlight that although general awareness regarding the benefits of insulin therapy is reasonably good, significant psychological, behavioural, and cultural barriers continue to hinder timely insulin initiation. Misconceptions, economic concerns, and limited physician–patient trust about insulin treatment play a crucial role in perpetuating psychological insulin resistance. Conclusion: Overall, patients demonstrated a relatively positive attitude toward insulin therapy, with minimal social stigma and fear of injections. However, persistent misconceptions, cost concerns, preference for alternative therapies, and lack of trust in physicians about insulin treatment advice particularly among insulin-naïve patients remain key barriers. Addressing these issues through targeted patient education, effective counselling, and strengthening doctor–patient communication is essential to improve acceptance and optimal use of insulin therapy in T2DM.