Audit of insulin prescription patterns and associated burden among diabetics in a tertiary health institution in Nigeria

Background: Insulin is one of the most important anti-diabetic agents in the management of diabetes even among type 2 diabetic. Objective: There was need to assess insulin adherence, mode of insulin delivery and burden of insulin usage among diabetics.Methods: A cross-sectional, prospective questionnaire, orally administered at a Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria. Participants were consecutive patients with diabetes who were 18 years or older presently on insulin either alone or in combination with other anti-diabetic agents for at least 3 months. Baseline demographic and insulin treatment information were obtained.Results: Two hundred and thirteen (213) participants were studied. Of these, 21 (9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 ± 13.1 years, mean duration of diabetes, 7.0 ± 6.9 years). Insulin adherence was noted in 72.8% with better adherence among those who self-injected insulin compared to those who were injected by health care professionals (HCPs) or relations. Among the respondents, 80.8% were on human insulin and pre-mixed insulin was the most commonly used form of insulin (52.6%). Most participants (52.6%) were taking 10-20 units per day, only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6% of the participants.  Major reasons for insulin omission were non-availability of insulin and patients being tired of insulin injection.Conclusion: The insulin adherence among diabetics in this study was high. Non-availability of insulin, insulin injection pain and being tired of continual insulin usage were some of the reasons for non-adherent to insulin usage.Keywords: Adherence, diabetes, burden, insulin injection, omission

Audit of insulin prescription patterns and associated burden among diabetics in a tertiary health institution in Nigeria

Background: Insulin is one of the most important anti-diabetic agents in the management of diabetes even among type 2 diabetic. Objective: There was need to assess insulin adherence, mode of insulin delivery and burden of insulin usage among diabetics. Methods: A cross-sectional, prospective questionnaire, orally administered at a Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria. Participants were consecutive patients with diabetes who were 18 years or older presently on insulin either alone or in combination with other anti-diabetic agents for at least 3 months. Baseline demographic and insulin treatment information were obtained. Results: Two hundred and thirteen (213) participants were studied. Of these, 21 (9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 \ub1 13.1 years, mean duration of diabetes, 7.0 \ub1 6.9 years). Insulin adherence was noted in 72.8% with better adherence among those who self-injected insulin compared to those who were injected by health care professionals (HCPs) or relations. Among the respondents, 80.8% were on human insulin and pre-mixed insulin was the most commonly used form of insulin (52.6%). Most participants (52.6%) were taking 10-20 units per day, only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6% of the participants. Major reasons for insulin omission were non-availability of insulin and patients being tired of insulin injection. Conclusion: The insulin adherence among diabetics in this study was high. Non-availability of insulin, insulin injection pain and being tired of continual insulin usage were some of the reasons for non-adherent to insulin usage

In-patient morbidity and mortality patterns among patients with diabetes in Southwest Nigeria: A multicenter prospective study

Background: Diabetes is a disease of public concern with increasing hospital admissions and mortality in developing countries. Hence, we aimed to determine the patterns of in-hospital morbidity and mortality in patients admitted for diabetes. Methods: A prospective multicenter analysis of the causes of hospital admission and death among patients with type 2 diabetes who were admitted from diabetic clinic and emergency units over a 3-month period in selected tertiary hospitals in southwest, Nigeria was conducted. Data analysis was performed using the SPSS version 21.0. Results: A total of 341 patients with diabetes were admitted with a mean age of 59.6 ± 15.6 years and overall mortality of 14 deaths (4.4%). Almost three-fifths (59.5%) were previously known patients with diabetes with a mean duration of 52.44 ± 30.02 months. Two hundred and thirty-one (70.9%) patients were admitted through the emergency units and others through outpatient clinics. The duration of hospital stay ranged from 1 to 135 days, with a mean duration of 24.5 ± 14.7 days. The diabetes-related indications for admission were hyperglycemic crisis (diabetes ketoacidosis [DKA] and hyperglycemic hyperosmolar state [HHS]) (59.8%), diabetic foot ulcer [DFU], (11.7%), hypoglycemia (7.6%), and infections (7.3%). Among the diabetes-related diagnoses, 100%, 77.8%, 50.0%, 41.7%, and 28.3% of patients with chronic kidney disease, stroke, DFU, DKA, and HHS respectively stayed longer than 10 days on admission. Conclusion: Diabetes still contributes high cause of morbidity in our hospitals but with a reduced mortality compared to previously reported figure. Hence, continued emphasis on early diagnosis with improvements in diabetes care will help to improve diabetes outcomes