Factors Associated with Delayed Initiation of Insulin Among Patients with Type 2 Diabetes Mellitus at the Diabetes Clinic of a Tertiary Hospital in Ethiopia: A Qualitative Study

Background: Guidelines recommend the initiation of insulin in patients with type 2 diabetes mellitus who failed on maximum doses of oral medication. However, time of initiation is inconsistent due to different barriers resulting in a delay which leads to failure to achieve glycemic control which in turn may lead to different complications. The aim of this study was to explore factors influencing the delayed initiation of insulin among patients with type 2 diabetes being managed at the Diabetes Clinic of Tikur Anbessa Specialized Hospital. Methods: A qualitative descriptive study design was employed. Data was collected using in-depth interviews with 27 participants, including patients and healthcare providers. Audio-recorded data was transcribed and then thematically analyzed. Results: Different factors influencing the delayed initiation of insulin in patients with type 2 diabetes mellitus were revealed. Patient factors included beliefs about the necessity of insulin and concerns related to starting insulin like fear of injections, non-amenability to religious practices, and perceived difficulty in its administration among others. Physician factors included patients' perceived situation and the lack of clinical competency as it is residents who play a major role in providing the diagnosis and treatment while also maintaining their attachment to the clinic. Health institution factors included inadequate laboratory set ups which only provided increased blood glucose tests and the absence of contextual guidelines for diabetes management including insulin initiation. Conclusions: The study findings indicated different influencing factors some of which were similar to those reported in other studies while there were others like perceived resistance to insulin which somehow were unique to the present study. These are indicative of the need to implement interventions such as strengthening the patients' diabetes health education program that is considerate of the religious, cultural, and social aspects of the society.