Multicentre Evaluation of Type 2 Diabetes Mellitus Outpatients on Insulin Therapy in Nigeria (METOIN Study)

Background: Insulin use in type 2 diabetes mellitus (T2DM) outpatients remains largely not well accepted in Nigeria. Both the physicians and the patients thread with caution whenever insulin is suggested as an outpatient treatment option. This study, therefore, is on the type 2 diabetes mellitus outpatients on insulin therapy despite the misgivings against insulin.

Methodology: This was a cross sectional study in which consenting T2DM outpatients who meet the inclusion criteria for the study in five tertiary health facilities were recruited and relevant data obtained via investigator-administered questionnaire between January 1, 2020 and December 31, 2021. Data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software.

Results: A total of 268 T2DM outpatients were recruited into the study, made up of 116 (43.3%) men and 152 (56.7%) women. Out of this, 212 (79.1%) patients did not start insulin from onset of the illness. Insulin initiation was done for 203 (75.7%) of the patients by endocrinologists in teaching and specialist hospitals. A total of 161 (69.1%) patients used insulin pen. Insulin was self-administered by 189 (70.5%) of the patients while intermediate acting insulin was the predominant insulin used by 127 (47.4%) of the patients. No insulin side effect was reported by 191 (71.3%) of the patients and 252 (94.0%) patients reported that insulin injection pain was not enough reason not to be on insulin. Of the total number of patients, 110 (41.0%) patients reported hypoglycaemia which was treated at home by 90 (81.8%) of the patients. A total of 225 (84%) patients had personal glucometers of which 182 (80.9%) patients had glucose strips at the time of being recruited into the study.

Conclusion / Recommendation: This study has shown that insulin is initiated for majority of patients several years after the onset of the illness and that insulin is initiated mainly at teaching and specialist hospitals. Insulin pens were predominantly used and most of the patients self administered insulin which had no side effects in majority of them. Self glucose monitoring of blood glucose was done by a majority of the patient. It is recommended that continuous diabetes education and improvement in insulin technology be done to increase insulin acceptance and usage.