The Effectiveness of Diabetes Conversation Map™ among Insulin Refusal Type 2 Diabetes Mellitus Patients

Abstract

INTRODUCTION: Majority of patients with type 2 diabetes mellitus (T2DM) will eventually need insulin therapy to optimise their blood glucose level. However, there is difficulties in initiating an insulin therapy due to high refusal rate among these patients. Diabetes Conversation Maps (DCM), a tool designed to educate patients with diabetes and their family members is available in Malay language since 2008. Although DCM has been used in certain centres in Malaysia, their effectiveness has not been evaluated. Thus, we have conducted a study to assess effectiveness of DCM compared to standard counselling therapy in T2DM patients who initially refused insulin therapy by assessing acceptance rate post intervention. MATERIALS AND METHODS: A randomized control study was conducted on 88 adults T2DM patients who initially refused insulin therapy in primary care clinics in Kelantan. A total of 44 patients received group based education using a Malay version DCM whereas another 44 patients received standard individual education. Results were analysed using a Chi-square analysis and the significant result was set at p value of <0.05. RESULTS: The response rate was 97.7% and there was a significant difference in insulin acceptance between these two groups. Eighty-six percent of T2DM patients in the intervention group education eventually accepted insulin initiation compared to only 11% in the control group (p<0.001). CONCLUSION: Group education using Malay Diabetes Conversation Map on insulin initiation is effective in increasing acceptance among patients who initially refuse insulin treatment in primary care. We recommend using DCM as part of educational module to improve patient diabetic management.