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Background: Most patients with type 2 diabetes mellitus (DM2) will require insulin for glycemic control during their disease. Objectives: We evaluated the willingness to start insulin therapy among insulin-naïve persons with DM2 in urban Northern Uganda. Design: A facility-based, quantitative, cross-sectional study was conducted between June and August 2023 recruiting insulin-naïve type 2 diabetes mellitus patients attending routine health care at Gulu Regional Referral Hospital, Gulu, Uganda. Methods: We gauged participants' willingness to use insulin by asking, 'If your doctor prescribed insulin for you, would you accept to use it?' with responses categorized as either 'Yes' or 'No'. Poisson regression analysis was performed to assess the factors associated with willingness to start insulin therapy. p < 0.05 were considered statistically significant. Results: We enrolled 190 participants, with a mean age of 55 ± 12.72 years. Most participants were female (63.7%, n = 121), attained a primary level of education (70.0%, n = 133), and were unemployed (84.2%, n = 160). Overall, 73.4% (n = 138) of the participants were willing to receive insulin therapy if indicated. Participants recently advised on insulin showed a 34% higher willingness [adjusted prevalence ratio (aPR): 1.34, 95% confidence interval (CI): 1.06-1.72, p = 0.007], whereas those with a disease duration of 6 years or more were 43% less willing (aPR: 0.57, 95% CI: 0.39-0.81, p = 0.002) and those concerns about coping with insulin therapy were 55% less willing to commence insulin therapy (aPR: 0.57, 95% CI: 0.39-0.81, p = 0.002). Conclusion: About three in every four participants with DM were willing to receive insulin if indicated. However, healthcare providers should consider personalized counseling strategies to alleviate concerns and enhance informed decision-making regarding insulin initiation. Future interventions should focus on addressing specific barriers associated with prolonged disease duration and apprehensions related to insulin therapy to optimize glycemic control in this population.
Exploring readiness for insulin treatment in people with type 2 diabetes at Gulu Regional Referral Hospital, Uganda In this study, we investigated the willingness to start insulin therapy among individuals with type 2 Diabetes Mellitus (DM2) in urban Northern Uganda. Understanding the importance of insulin for glycemic control in DM2, we surveyed 190 participants at Gulu Regional Referral Hospital. We found that more than three-quarters of the participants expressed a willingness to receive insulin therapy if recommended. Factors influencing this willingness included recent advice on insulin, which was associated with a 34% higher likelihood of acceptance. Conversely, individuals with a disease duration of 6 years or more were 43% less willing, and those concerned about coping with insulin therapy were 55% less willing to commence treatment. These findings underscore the need for healthcare providers to offer personalized counseling strategies, addressing specific concerns, to facilitate informed decision-making regarding insulin initiation. Looking ahead, interventions should prioritize overcoming barriers related to prolonged disease duration and apprehensions about insulin therapy to optimize glycemic control and improve the well-being of individuals with DM2 in this population.
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INTRODUCTION: Follow-up visits are recommended to all voluntary medical male circumcision clients (VMMC), however, adherence is variable. High lost-to-follow-up cases limit knowledge about clinical status of clients and adverse events. This study sought to establish Motivators and Barriers to the Uptake of VMMC post-operative follow-up services in Siaya County, Kenya. METHODS: 277 clients from five VMMC sites in Yala were recruited immediately post-operation to participate in a telephone interview between the 21st and 31st day post-surgery during which a semi-structured questionnaire was administered. Descriptive and inferential statistics was used to analyse quantitative information using SPSS while responses from open ended questions were grouped into themes, sieved out, coded and analyzed. RESULTS: 137(49.5%) of the 277 participants utilized the follow-up services. Health education (31.4%) and emergency reviews/adverse events (24.1%) were the main motivation for returning for follow-up while occupational and other engagements (29.7%) and presumption of healing (24.6%) were the main barriers. Type of facility attended (p=0.0173), satisfaction with the discharge process (p=0.0150) and residency in Yala (p<0.001) were statistically significant to the respondents' return for follow-up. 85(62.0%) of the participants returned on the 7th day, 9(6.6%) returned after 7 days, and 43(31.4%) returned before 7 days. CONCLUSION: VMMC health education should include and emphasize the benefits of follow-up care to the clients and the providers should address the barriers to accessing follow-up services. Our results will inform the programme on areas identified to improve care for VMMC clients and reduce subsequent lost-to-follow-up cases.