Predictors of insulin adherence among patients with type 2 diabetes: a cross-sectional study

Type 2 diabetes (T2D) is a chronic metabolic disorder requiring insulin therapy as β-cell function declines. Despite insulin's proven efficacy, adherence remains a significant challenge. This study aims to identify factors influencing insulin adherence among patients with T2D to inform targeted clinical interventions.

A cross-sectional study was conducted at a tertiary diabetes clinic, recruiting adult patients with T2D on insulin therapy for at least six months. A structured, validated questionnaire was administered in person to collect demographic, clinical, and treatment-related data, along with patient beliefs about insulin. Insulin adherence was defined as taking ≥80% of prescribed doses over the past month. Statistical analysis included univariate and multivariate logistic regression to identify independent predictors of adherence.

Among 111 patients, 49 (44.1%) were adherent, while 62 (55.9%) were non-adherent. Adherence was associated with male gender, higher education levels, smoking abstinence, and adherence to recommended diet and exercise regimens. Non-adherent patients had a higher prevalence of family history of diabetes, more diabetic complications, increased comorbidities, and more frequent hospitalizations. Self-injection of insulin and regular self-monitoring of blood glucose were linked to better adherence, whereas fear of injections and the use of herbal medicine were associated with lower adherence. Negative beliefs about insulin were not significantly different between groups.

Insulin adherence in T2D is influenced by lifestyle, clinical, and practical treatment factors rather than negative beliefs alone. Addressing practical barriers, such as fear of injection and alternative treatment use, through patient education and supportive interventions may improve adherence rates.