Insulin adherence in patients with diabetes: risk factors for injection omission

Prim Care Diabetes. 2014 Dec;8(4):338-45. doi: 10.1016/j.pcd.2014.03.001. Epub 2014 Apr 8.


Aims: The purpose of this study was to evaluate adherence to insulin therapy in patients with diabetes. The underlying factors affecting insulin injection omission among patients with type 1 or 2 diabetes were also investigated.

Methods: This cross-sectional study has been conducted on 507 patients with diabetes. Adherence to insulin therapy was measured by the 8-Item Moriskey Medication Adherence Scale (MMS) and the autocompliance method. Furthermore, socio-demographic, disease and injection-related barriers to insulin injection were assessed.

Results: Based on the Morisky Green test, 14.3% and 28.8% of patients with type 1 and 2 diabetes respectively had low adherence to insulin therapy. However, almost all patients were adherent according to the autocompliance method. Different factors showed a significant association with insulin compliance in both groups.

Conclusions: The current study suggests acceptable adherence to insulin therapy among patients with type 1, and poor adherence in patients with type 2, diabetes. Our findings regarding barriers with significant effect on insulin adherence may be useful to identify patients at risk for low compliance, and to guide the design of proper strategies to improve adherence and the consequential clinical outcomes.

Keywords: Adherence; Barrier; Diabetes mellitus; Insulin.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / psychology
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / psychology
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Hypoglycemic Agents / administration & dosage*
  • Injections
  • Insulin / administration & dosage*
  • Male
  • Medication Adherence*
  • Middle Aged
  • Risk Factors
  • Surveys and Questionnaires
  • Young Adult


  • Hypoglycemic Agents
  • Insulin