Insulin use, prescription patterns, regimens and costs.-a narrative from a developing country

This was a Cross-sectional observation Study whereby 160 patients with DM who were on insulin solely or in combination with oral hypoglycaemic agents were recruited over a 6 month period. Information obtained from the Study subjects pertained to their histories of DM, types of insulin, insulin costs, adherence issues and insulin delivery devices. Long and short term glycaemic control were determined and evaluated for possible relation to insulin adherence. Test statistics used were chi square, t test and binary regression.Insulin adherence was noted in 123-77% of the Study subjects and this was comparable between persons with type 1 DM and those with type 2 DM. The mean glycosylated haemoglobin values were significantly higher in those who admitted to non insulin adherence compared to those who adhered to their insulin regimen (9.7% (2.3) Vs 8.6% (2.1), p？=？0.01). Reasons proffered by Respondents for non insulin adherence included high costs-15(41%), inconvenience ？15 (41%) and needle pain-79)18%. A greater proportion of persons who self injected insulin adhered to insulin prescriptions compared to those who did not self inject and thus had better glycaemic control. Shorter duration of DM and older age were found to be predictors of adherence to insulin prescription.The monthly mean costs of insulin for those who earned an income was 5212.8 Nigerian naira which is equivalent to 33.1 US dollars and we estimated that persons on a minimum wage would spend 29% of their monthly income on the procurement of insulin.Health related costs, age, duration of DM and insulin associated side effects are some of the factors implicated in adherence to insulin prescription.The prevalence of diabetes mellitus (DM), is on the rise worldwide and this is more so in the developing countries which unfortunately are already overburdened by a high disease burden arising from communicable diseases. It is estimated that by the year 2030, over 70% of people with diabetes will reside in develop