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Lack of Adherence to Insulin Medication in Type 1 Diabetes Mellitus Patients: What’s causing it?

    The authors of the article are: Zaina Asad: Zaina is pursuing her Master's in Clinical Psychology from CMR University, Bangalore. Dr. Moitrayee Das: Moitrayee is an Assistant Professor of Psychology at FLAME University, Pune. Many Type 1

 

 

The authors of the article are:
Zaina Asad: Zaina is pursuing her Master’s in Clinical Psychology from CMR University, Bangalore.
Dr. Moitrayee Das: Moitrayee is an Assistant Professor of Psychology at FLAME University, Pune.

Many Type 1 Diabetes cases especially in children go unnoticed or are not reported due to the child’s death. These deaths mainly occur due to a lack of knowledge of the health condition or financial support, as insulin medication can be costly. However, there is definitely a gradual increase in Type 1 Diabetes cases as more people are aware of the condition, and India has developed significantly in the technology and healthcare segments. (Virmani, 2019).
The features of Type 1 Diabetes are caused by the body destroying pancreatic beta cells, thus leading to insulin no longer being produced in the body. This then has consequences of hyperglycaemia, ketoacidosis and could lead to death if the body’s sugar levels are not controlled with the help of insulin. Type 1 Diabetes can contribute to other health problems such as poor eyesight, poor immune system, slower healing process etc. (Das, 2015).
Potential health behaviours important for those with Type 1 Diabetes include maintenance of blood glucose levels, through insulin therapy, exercise, diet control, HBA1C and other medical check-ups. It is a constant struggle between monitoring blood glucose levels and also maintaining a balanced lifestyle. Health behaviours include regular HBA1C, eye and other health check-ups, exercise, a healthy and balanced diet, avoidance of food items that contain large amounts of sugar, and adherence to timely insulin shots. These health behaviours are crucial to maintaining a normal life and also to avoid any long-term complications. Poor maintenance of blood sugar levels can lead to severe consequences which can affect other bodily functions, hence adherence to insulin therapy is of utmost importance. Due to this importance, the health behaviour that will be taken into consideration is ‘adherence to timely insulin medication’. (Das, 2015). The time of insulin taken also matters a lot and can have direct effects on blood glucose levels, hence making sure timely adherence to insulin therapy is also an essential aspect of the health behaviour.
The Health Belief Model
The model of behaviour taken into consideration is The Health Belief Model. It is a theoretical framework that states a person’s willingness to alter their health behaviours is mainly due to how they perceive the health condition’. This model would be appropriate in investigating adherence to insulin therapy in Type 1 Diabetes because this model is known to be used for inducing self-care activities, and mostly ‘management’ of health conditions. (Adejoh, 2014).
Through research findings perceived susceptibility, perceived benefits, and cues to action can be constructs that are necessary to be targeted for an intervention for insulin adherence. Keeping the Indian population in mind, perceived barriers and perceived severity can play a role, as many are unaware of the many complications poor management of Type 1 Diabetes can cause.
Perceived susceptibility, is the human instinct to want to prevent oneself from further complications and harm even after being diagnosed with a complicated health condition, like that of Type 1 Diabetes. For this reason, this construct is necessary to be targeted and used to the advantage in trying to motivate Type 1 Diabetic patients to adhere to insulin therapy by bringing awareness programs and facilitating psychological interventions in the same aspect.
Perceived benefits, especially in terms of the Indian mentality, actions or behaviours are always done for a reason. Some immediate outcome needs to be achieved or else they feel that their efforts (be it monetary or mental) are going in vain. Hence informing them of the benefits of adhering to insulin medication, and the consequences of not adhering can produce a change.
Cues to Action, once again would work well if incorporated in psychological interventions. Showing people leading a wonderful life with Type 1 Diabetes and how they are doing it, can definitely encourage a lot of people and also give them the motivation to engage in the same.
Perceived barriers, this construct is very vital, especially for the Indian population. This is mainly because there are a number of cases relating to poverty. It has also been proved to be one of the cases as to why the total number of Type 1 Diabetes cases is lower than reality, as those who have the health condition either don’t know they have it, or they die due to no medication or any sort of medical management. Insulin medication is definitely very costly and it is a life-long requirement. Hence financial issues are a huge barrier for many people in India.
To conclude, Type 1 Diabetes is definitely a very complicated health condition and is a constant juggle in managing the fluctuations in blood glucose levels. However, with effective health behaviours, such as adherence to ‘timely insulin medication’, individuals can live a happy and normal life. The Health Belief Model constructs definitely can be very useful in planning out interventions to maintain and manage this health condition. Proper management and psychological support is the only thing that will help an individual in combatting Type 1 Diabetes.

References
Adejoh, S. O. (2014). Diabetes Knowledge, Health Belief, and Diabetes Management Among the Igala Nigeria. SAGE Open, 1-8.https://doi.org/10.1177/2158244014539966
Alatawi, Y. M., Kavookjian, J., Ekong, G., &Alrayees, M. M. (2016). The association between health beliefs and medication adherence among patients with type 2 diabetes. Research in social & administrative pharmacy : RSAP, 12(6), 914–925.https://doi.org/10.1016/j.sapharm.2015.11.006
Cerkoney, K. A., & Hart, L. K. (1980). The relationship between the health belief model and compliance of persons with diabetes mellitus. Diabetes care, 3(5), 594–598.https://doi.org/10.2337/diacare.3.5.594
Das A. K. (2015). Type 1 diabetes in India: Overall insights. Indian journal of endocrinology and metabolism, 19(Suppl 1), S31–S33.https://doi.org/10.4103/2230-8210.155372
Elizabeth Boskey, P. D. (2020). How the health belief model influences your health choices. Verywell Mind. Retrieved October 31, 2021, from https://www.verywellmind.com/health-belief-model-3132721.
Fitriani, Y., Pristianty, L. &Hermansyah, A. (2019). Patients’ characteristics and their adherence to insulin therapy. Journal of Basic and Clinical Physiology and Pharmacology, 30(6). 20190330.https://doi.org/10.1515/jbcpp-2019-0330
Insulin. (2020). Retrieved October 31, 2021, from https://www.diabetes.co.uk/body/insulin.html.
Virmani, A. (2019). Type 1 Diabetes in India: The Numbers Show the Way Ahead. Indian Pediatrics, 56. [Editorial].

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