Factors associated with KAP results, ADRs and glycemic control status
We found a significant relationship between the patient’s better knowledge and the patient’s longer duration of insulin therapy (≥ one year) (p = 0.025) and receiving consultation from health professionals (p = 0.001). Several recent studies have shown the importance of hospital pharmacists performing patient education for diabetes mellitus9,13,22.
Patients with longer insulin treatment are likely to have a more positive attitude (p = 0.017). This result is similar to the study of Cosson E.21 conducted in France in 2019 patients after using insulin reported fewer negative feelings and more positive feelings.
Our study also found that patients improved their attitude after changed from vials to the use of a pen (p < 0.001). This is consistent with Ramadan et al.’s study23 in which 85.7% of pen users found it more convenient shifting to pen and the insulin pen was significantly less painful than the conventional vial/syringe.
Patients using insulin combined with oral anti-diabetic drugs (OAD) had better attitude on insulin role (p=0.038). A similar KAP survey in India6 found that patient using insulin with longer duration of OAD use (≥ 3 years) was associated with better perception on benefits of insulin use (p < 0.001), awareness that insulin is not habit forming in nature (P  = 0.001), need for continuity in insulin use (p = 0.002), and the confidence for self-administration of insulin (p = 0.042).
Duration on insulin therapy (≥1 year) and patient’s good knowledge significantly improved the patient’s practical skills (p = 0.042 and <0.001, respectively). Then, patients with good injection technique were less likely to get ADRs in injection sites (p=0.013). Mitchell et al. reported that correct usage scores of insulin pens were significantly higher if initial education on insulin pens was performed by a pharmacist or nurse9.
Our study found that KAP levels did not correlate with both FPG and HbA1c control status. However, the study of Solanki et al. in 201724 recorded that there was positive correlation between KAP score and glycemic control, with significance for only glycosylated hemoglobin and not fasting blood sugar, postprandial blood sugar. One of the reasons maybe that our KAP questionnaire only focused on hypoglycemia and insulin pens but not cover broad diabetic management.