Practice Implications

The findings of this study have provided valuable insights that further our understanding of the complexities of initiating insulin treatment among T2DM patients in Malaysia and how they perceive insulin treatment. This section draws on the findings of this study and presents the implications for healthcare providers working in the field.

This study raises several issues that are of importance to T2DM patients in Malaysia. The findings of this study suggest that there is a lack of awareness of modern insulin pen devices. Many patients associate insulin injections with past experiences with injections such as vaccinations, which is a complicated procedure and involves drawing medicine from glass vials via needles and administered either via intramuscular or intravascular (Tan et al. 2011;

Korytkowski 2002). As a result, patients perceive that injecting insulin is a complicated procedure, which required intensive technical training and precision. Additionally, patients would relate injection to syringe and needles and fear of needles and perception of pain (see Figure 9 Consequences of lack of awareness of modern insulin pen devices).

Figure 9 Consequences of lack of awareness of modern insulin pen devices

The development of insulin pen devices has greatly reduced these negative perceptions. Ease of learning how to use a modern insulin pen is a crucial factor for encouraging early acceptance of insulin treatment (Spollett 2008).

The availability of modern insulin pen devices is particularly useful for insulin-naive patients, elderly patients, and those patients with visual or manual dexterity disabilities. Modern insulin pen devices are not only easy to handle, easy to use, but also can improve dosing accuracy compared with conventional needles and syringes (Meece 2008). The pen-shaped design of insulin injection also provides more flexibility and convenience to patients;

their compact size allows ease to carry around and discreet insulin administration.

Thus, many barriers of using insulin injections could be addressed at the early stage of T2DM by making patients aware the availability of modern insulin

pen devices. It would be particularly beneficial for those patients who have not seen insulin pen devices before; healthcare providers could demonstrate the injecting procedure and let the patients experience handling the pen devices.

During counselling, emphasis should be placed on both practical and emotional support in order to help patients to accept insulin treatment and become more self-efficient to use insulin injection.

To alleviate the negative perceptions of insulin injection by Malaysian society, educational campaigns directed to the public are needed to raise awareness of diabetes and the important role of insulin treatment; subsequently to ease the patients with Type 1 and Type 2 diabetes mellitus to be more acceptable about self-injecting in public. These campaigns should encourage society to be more open minded towards insulin treatment and address the current social stigma toward self-injecting insulin in public.

Awareness of T2DM and role of insulin injections should be promoted to a wider community not limited to only healthcare facilities. The Malaysian Health Promotion Board, MySihat (Sihat means Health in Bahasa Malaysia), was established in 2006 to support non-profitable organisation and community empowerment (Kaur et al. 2011). MOHM and MySihat could evolve to take on a bigger role in enhancing diabetes awareness in Malaysia. This could be promoted at many levels, including schools, work places, and community events across the country. It should also be promoted in the media to a wider range of audience via local television or social media, such as having an acting character in a drama or video clip portraying T2DM patient who is using

insulin injections. It would help the audience understand the difference between recreational drugs and insulin injection, and also the importance of insulin treatment to some T2DM patients. The perception of social stigma need to be addressed so patientsÕ understanding of and adherence to insulin treatment only able to be translated into practice.

Early diabetes education should make T2DM patients more aware of the progressive nature of T2DM and the function of insulin, this would better prepare them mentally for insulin treatment in the future especially to allay the negative perception of personal failure. This suggestion to have early discussion about insulin treatment corresponded to the suggestion by Hassali et al. (2013).

Healthcare providers across different disciplines such as doctors, pharmacists, and diabetes nurses should have a systematic program in place for early diabetes education to enhance the patientÕs knowledge and awareness.

Healthcare providers should provide adequate but simplified practical support together with emotional support when suggesting insulin treatment. PatientsÕ concerns relating to insulin dosing need to be addressed early on and healthcare providers also need to take into account of individual patientsÕ needs and tailor the insulin treatment to fit into patientsÕ lifestyles.

Starting T2DM patients on a simple insulin regime such as once-daily injection with insulin glargine is a good strategy to overcome the fear and worry that insulin treatment is restrictive and complicated to handle. Simpler insulin

regimes provide more freedom and convenience, therefore causing minimal disruption to a patientÕs daily activity and therefore would ease the transition from oral anti-diabetic medication to insulin treatment. Practical and emotional support are both important to help patients getting into routine and minimising the disruption to their lifestyle.