Factors Associated with Insulin Nonadherence in Type 1 Diabetes Mellitus Patients in Mexico

Abstract

Background: Lack of adherence to insulin therapy is common among patients with type 1 diabetes. Factors associated with insulin omission in adult persons with type 1 diabetes in Latin America have not been studied in detail. Objectives: To investigate factors associated with insulin nonadherence including the presence of psychological disorders (disordered eating behaviors and depression) in adult patients with type 1 diabetes. Methods: Cross-sectional study including 104 consecutive adults (≥18 years old) attending a tertiary care center in Mexico City. Adherence to insulin therapy was measured with a specific item in a questionnaire. Sociodemographic data and factors related to insulin omission, including validated questionnaires to evaluate disordered eating behavior and depression, were collected and compared between the nonadherent and adherent groups with parametric or nonparametric statistical tests, as appropriate. Results: We classified 51 (49.1%) patients as nonadherent and 53 (50.9%) as adherent. Adherent subjects reported that they planned their activities around insulin application more often than the nonadherent subjects did (43.4 vs. 23.5%, p = 0.032). In a logistic regression model, fear of hypoglycemia (OR = 11.39) and economic reasons (OR = 6.02) were independently associated with insulin adherence. Presence of disordered eating behavior was identified in 14.4% of subjects, the majority belonging to the nonadherent group. Conclusions: Only 50% of the patients with type 1 diabetes were adherent. The principal factors associated with nonadherence were economic reasons and fear of hypoglycemia.