Assessing Knowledge and Practice of Self-Administration of Insulin among Diabetes Mellitus Patients: Implications for Enhanced Diabetes Care

The term ‘diabetes’ finds its origins in ancient Egyptian civilization, where it was first used to describe a condition characterized by weight loss and excessive urination. In Greek, the word ‘diabetes’ translates to ‘to pass over’, while ‘mellitus’, derived from Latin, means ‘honey’ or ‘sweetness’, referring to the sugary nature of the condition. Recent research indicates a projected increase in the prevalence of diabetes mellitus, with an estimated 6.4% rise expected by the year 2025.^1,2 According to the World Health Organization more than 422 million individuals worldwide affected by Diabetes Mellitus (DM).³ It is a chronic metabolic disorder with significant global impact. Understanding its types, etiology, epidemiology, clinical manifestations, diagnosis, and management strategies is crucial for healthcare professionals and researchers.^4,5

Insulin injection is deemed essential for individuals with type I diabetes mellitus and often becomes necessary as type II diabetes mellitus progresses. A significant proportion of type II diabetes mellitus patients eventually require insulin for blood glucose control. Hence, evaluating their knowledge and practice regarding insulin injection, even if they are not currently using this medication, is deemed important to identify potential gaps in understanding. It is a prevalent and challenging health condition that requires diligent management to prevent complications and improve patient outcomes. Self-administered insulin management plays a pivotal role in diabetes care, empowering patients to actively participate in their treatment.

However, achieving optimal insulin self-administration can be hindered by various factors.⁶ Therefore, understanding the level of knowledge and practice regarding insulin self-administration among diabetes mellitus patients is crucial for developing targeted interventions and tailored educational strategies. This study aims to evaluate the knowledge and practice of insulin self-administration, analyze associations with socio-demographic variables, and explore potential correlations between knowledge and practice scores. By identifying areas of improvement, healthcare providers can implement effective measures to enhance diabetes care and empower patients in their self-management journey.

Knowledge about the disease plays a crucial role in preventing and diagnosing diabetes mellitus. Research papers have shown that providing substantial education about diabetes mellitus to the general population leads to a significant improvement in disease-related knowledge. Heightening knowledge, especially related to self-management, is particularly beneficial for individuals with diabetes mellitus.^7,8

Effective self-control and self-management of diabetes mellitus contribute to the overall well-being of patients. Education is a fundamental component of self-management in insulin therapy. Teaching patients about the self-administration of insulin fosters self-confidence. Nurses have the responsibility of instructing patients in insulin self-injection as soon as the need for insulin has been determined. This instruction can be delivered through written or verbal guidance and demonstration techniques, helping patients better manage their condition.^9,10 Nonetheless, numerous patients encounter difficulties in insulin administration. Hence, the present study is planned to assess knowledge and practice of self-administering insulin in diabetes mellitus patients, as well as examine associations with socio-demographic factors.

In this study, a non-experimental descriptive research design was employed, utilizing a convenient sampling technique. A total of 300 participants were chosen from both out-patients and in-patients attending a tertiary care Dhiraj hospital located in Vadodara, Gujarat, India. The research project received ethical approval from Sumandeep Vidyapeeth Institutional Ethical Committee; Approval number: BNPG181D19021 and informed written consent was obtained from all study participants prior to data collection.

The study included patients diagnosed with DM who had been self-administering insulin for a duration exceeding three months and who expressed their willingness to participate. Participants with severe complications of diabetes mellitus, gestational and juvenile diabetes, medical professionals, and those under the age of 18 were excluded from the study as shown in Figure 1.

Figure 1:
Method of Population Selection.

Data collection was conducted through the administration of twenty structured questionnaires to assess the participants’ knowledge scores. Additionally, a modified four-point practice checklist, comprising 18 statements, was employed to gauge the level of practice score concerning self-administration of insulin. This approach ensured a comprehensive assessment of participants’ knowledge and practical skills related to insulin self-administration. The data obtained were analysed employing both descriptive and inferential statistical analyses.

A significant portion of the study participants, specifically 44.67% (134), fell within the age range of 51 to 60 years, and in terms of gender, a majority (80%, i.e., 240) were male. Regarding educational background, 52.33% (157) of the participants had completed primary education. In terms of employment, 33.0% (99) of the participants were unemployed. When considering the duration of DM, a substantial 88.0% (264) of the participants reported having had DM for a duration ranging from 0 to 5 years. Impressively, a significant 87.33% (262) of the participants possessed knowledge related to DM. Interestingly, 51% (151) of them had a specific source of knowledge about DM. Additionally, a noteworthy finding was that the majority (86.67%, i.e., 240) of the study participants had a history of diabetes mellitus, emphasizing the prevalence of the condition among this group.

Table 1 illustrates the distribution of knowledge scores and practice scores among diabetes mellitus patients. A significant majority, accounting for 72.33% (217), exhibited a moderate level of knowledge. Moreover, 27.66% (83) of the participants exhibited a satisfactory level of knowledge, and upon reviewing their practice scores among diabetes mellitus patients, 4.33% (13) of them displayed an excellent practice score, with an additional 11.67% (35) demonstrating a good practice score. The majority, comprising 77.0% (231) of patients, showed an average practice score, and 7.0% (21) of patients had a poor practice score.

Table 2 explores the association between knowledge scores and specific demographic variables. It’s worth highlighting that among these demographic factors, the education was the only one found to have a significant association with knowledge scores. Conversely, all other demographic variables were deemed non-significant in relation to knowledge scores.

Table 3 delves into the relationship between practice scores and specific demographic variables. It’s important to note that significant demographic variables that displayed an association with practice scores encompassed education, occupation, and the source of knowledge. Conversely, the remaining demographic variables were determined to be non-significant concerning practice scores.

Table 4 indicates that there was no observed correlation between knowledge scores and practice scores related to self-administration of insulin among Diabetes Mellitus (DM) patients.

Diabetes presents a growing health concern in India, leading to significant complications such as neuropathy, nephropathy, retinopathy, coronary artery diseases, stroke, and peripheral vascular diseases. The treatment of diabetes mellitus encompasses the use of antidiabetic medications and insulin therapy, combined with lifestyle adjustments like maintaining a balanced diet and engaging in regular exercise.^11,12 Various factors contribute to the challenges in achieving therapeutic goals, including patients’ reluctance to adhere to treatment regimens. Despite the evident therapeutic benefits and advantages of insulin therapy, many patients are hesitant to initiate such treatment due to concerns about pain and the social stigma associated with using syringes.¹²

Understanding, consideration and coordination are essential when implementing insulin therapy for individuals with type I and type II diabetes mellitus, as well as those responsible for their diabetes care. It’s important to recognize that there is no one-size-fits-all approach to insulin therapy. The dosage of insulin varies depending on the individual’s blood glucose levels and the specific types of insulin used. Consequently, insulin therapy must be personalized to align with the individual’s lifestyle and address specific diabetic complications.

The findings from the current study disclosed that, when considering demographic variables viz. age, gender, occupation, duration of DM, source of knowledge and family history etc. were found to be not significant influencing knowledge scores. However, education showed a significant association. Regarding practice scores and demographic variables, significant associations were observed with education, occupation and source of knowledge. Age, gender, duration of DM, knowledge regarding DM, family history, however, did not exhibit a significant relationship. It is noteworthy that there was no apparent correlation between knowledge scores with practice scores in the context of self-administration of insulin among diabetes mellitus patients. This implies that an enhancement in knowledge scores is likely to result in improved practices among diabetes mellitus patients when it comes to self-administering insulin.

It is worth mentioning that a similar research study conducted by Workneh Fego M and colleagues (2021) reported that patients of Bedele Hospital, Southwest Ethiopia demonstrated a good understanding of insulin self-administration, exhibited proficient practices, and maintained a positive attitude toward the process. Nevertheless, the study highlighted the need for further strategies to attain the highest level of patient care.¹³ Additionally, Sunny A et al. (2021) identified a statistically significant positive correlation between knowledge and practice.¹⁴ Nasir BB et al. (2021) findings indicated that patients exhibited suboptimal knowledge and attitudes concerning insulin self-administration, and instances of malpractice were reported. Consequently, it is imperative to rectify these deficiencies through regular patient education and hands-on demonstration of insulin injection during each hospital visit.¹⁵

The sampling method employed in this study carries a notable risk of sampling bias, which could lead to results that may not precisely depict the relationship between knowledge and practice. Despite this limitation, the study can serve as a valuable pilot study for future research within the same population, offering a foundation for more accurate results in subsequent studies. Another constraint of our research was the predominantly low level of education (primarily primary education) and unemployment within the study’s population. Given that both of these factors significantly influence medication usage among individuals, it is plausible that the practice scores might skew towards the average and poorer side. Moreover, the study predominantly comprised a male population, representing a potential limitation, as it hinders a proper comparison between both genders. To reveal the actual gender-based differences in the population, further research is needed with an equal distribution of samples among both genders. The study’s duration and site constraints also raise the possibility that the enrolled population may differ from other hospital populations, making it challenging to comprehensively address population diversity.

In summary, our study indicates a lack of significant correlation between knowledge and practice in the context of insulin self-administration among diabetes mellitus patients. This underscores the critical need to focus on bolstering both knowledge and practical skills to promote improved self-administration of insulin. To address this imperative, healthcare professionals, particularly doctors and nurses, should play a pivotal role in educating patients during routine hospital follow-up visits. Delivering essential education and foundational knowledge on insulin self-administration can be instrumental in positively influencing the practice behaviours of individuals with diabetes mellitus. These efforts aim to enhance patient empowerment and adherence to effective insulin management strategies, ultimately contributing to better outcomes in diabetes care.

The sampling method employed in this study carries a notable risk of sampling bias, which could lead to results that may not precisely depict the relationship between knowledge and practice. Despite this limitation, the study can serve as a valuable pilot study for future research within the same population, offering a foundation for more accurate results in subsequent studies. Another constraint of our research was the predominantly low level of education (primarily primary education) and unemployment within the study’s population. Given that both of these factors significantly influence medication usage among individuals, it is plausible that the practice scores might skew towards the average and poorer side. Moreover, the study predominantly comprised a male population, representing a potential limitation, as it hinders a proper comparison between both genders.

To reveal the actual gender-based differences in the population, further research is needed with an equal distribution of samples among both genders. The study’s duration and site constraints also raise the possibility that the enrolled population may differ from other hospital populations, making it challenging to comprehensively address population diversity.

We are thankful to Sumandeep Vidyapeeth (Deemed to be University) for providing necessary platform. We also thank Medical Superintendent & Hospital staff of Dhiraj Hospital for constant support and successful completion of this study.