Conference abstract

Reasons for discontinuation of insulin therapy in African countries: results from the International Diabetes Management Practices Study (IDMPS)

Pan African Medical Journal - Conference Proceedings. 2021:11(43).01 Dec 2021.
doi: 10.11604/pamj-cp.2021.11.43.976

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Keywords: Africa, T1D, T2D, discontinuation, insulin
Oral presentation

Reasons for discontinuation of insulin therapy in African countries: results from the International Diabetes Management Practices Study (IDMPS)

Jean Claude Mbanya1,&, Jean-Marc Chantelot2, Pablo Aschner3, Juan José Gagliardino4, Hasan İlkova5, Fernando Lavalle6, Ambady Ramachandran7, Marina Shestakova8, Juliana Chung-Ngor Chan9

1Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, and Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon, 2Sanofi, Paris, France, 3Javeriana University School of Medicine and San Ignacio University Hospital, Bogotá, Colombia, 4CENEXA, Center of Experimental and Applied Endocrinology (La Plata National University - La Plata National Scientific and Technical Research Council), La Plata, Argentina, 5Istanbul University, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, Istanbul, Turkey, 6Facultad de Medicina de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico, 7India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India, 8Endocrinology Research Center, Moscow, Russia, 9Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China

&Corresponding author

Introduction: adherence to insulin therapy is often suboptimal and identifying barriers to therapy is essential to improve adherence. We studied the reasons for physician-defined discontinuation of insulin by people with diabetes in Africa. Methods: the IDMPS is a global observational study of the management of people with type 1 (T1D) and type 2 (T2D) diabetes. In 2016-2017, participants were enrolled from 24 countries, including 12 countries across Africa. Results: in people with T1D (N=788), 22.8% discontinued insulin without physician consent (median discontinuation period: 1 month). Main reasons given were cost (43.1%) and impact on social life (36.2%). Of people with T2D who received insulin (N=878), insulin discontinuation without physician indication was reported by 17.8% of people receiving insulin alone and 17.0% of people receiving insulin + oral glucose-lowering drugs (OGLD); median discontinuation period: 2 months. Reasons for discontinuation included impact on social life (31.0%) and lack of experience in insulin dosing (26.2%) for people receiving insulin alone, and cost (32.7%), and fear of hypoglycaemia (26.2%) for people receiving insulin + OGLD. The nature of discontinuation, e.g. type of missed injections (1 prandial or 1 basal insulin [basal-bolus regimen] or 1 premixed insulin) is unknown; pattern of insulin discontinuation (e.g., a definitive/temporary stop, or missed injection[s]) was not documented. Conclusion: details of missed injections (e.g. type of insulin, pattern of discontinuation) are not well documented. These observations urgently call for remedial measures, such as patient's education and access to affordable therapy, to improve treatment adherence and optimize outcomes.