Introduction

The word ‘Diabetes” is a sweet word, because it pertains to the sugar in the
blood. Most of us will be connected to this thing in some other ways. We may have
known someone with diabetes, maybe popular people in our society, others are our co
-worker, neighbors, friends, one of our family member, and even one of us already have
it because of its epidemic status.

According to the recent statistic, by the 2027, the rate of Filipinos with Diabetes
will grow to as much as 8 million cases which make it the 9 th leading cause of death in
the country. This was according to the Department of Health (DOH) health indicator
statistics. Diabetes currently affects 1 out of 25 (approximately 3.36 million) Filipinos,
the mortality rate of which averaging about 2.1 percent per year, with a steady annual
increase of 2.5 percent.1

When blood glucose tops 125 mg/ dl you are considered diabetes. It has been
shown that fifty percent of your pancreatic beta cell was damage. Diabetes is a chronic
and progressive disease meaning it cannot be cure. But there are lots of ways and
means that can help to control hyperglycemia; diet, exercise, lifestyle modification,
stress management and medicines to avoid further complications and even death.

Fortunately some patients can control their diabetes for years with a good diet
and exercise routine plus one, two, or even three different medications. However, there
are many conditions that may render these drugs either ineffective or no longer safe for
the patient. These include acute infections or other serious illnesses, pregnancy, major
surgery, CHF, Kidney Disease, Liver Disease, Tuberculosis and use of other drug like
steroids and some psychiatric medications.2

Unfortunately, many people with type 2 diabetes experience progressive loss of

beta cell function. Their overworked beta cells seem to burn out, and drugs that were
once effective were now ineffective .The pancreas will releases little or no more insulin
resulting in blood sugar level of 200 and above. As the disease progresses all this fail,
that is the time that the doctor will tell you need to start insulin injection.

1
Eugenio, Aldwin Eugene. Empowering the Nation Against Diabetes. Diabetes Direction2007 Vol.1 no.3 pp.3-4.
2
http://www.diabeteshealth.com/read/2009/03/20/5564/insulin-for-type-2-diabetes-who-when-and-
why/
 Patients have different reactions at the moment they heard insulin. For the first
timer or those that are insulin naïve, this is a big change in their lives. Patient becomes
anxious, sad and mixed emotions were seen on their face. What so simple for us to say
become so complex for the patient. With my personal experiences as a diabetes nurse
educator, working on a diabetes clinic, I can count to my finger those that accept insulin
treatment without apprehension. But most of them are reluctant , will be bargaining to
the physician promising to be a good patient not knowing that delay of insulin treatment
will cause future complications.

Timely initiation of insulin therapy in type 2 diabetes is important to achieve

metabolic control but can be hindered by negative perceptions of patients regarding
insulin treatment.3

The first aim of the study is to explore the barriers of which affect the decision of
insulin requiring patient. Secondly, when these barriers were identified, does patient
education and health teaching will change their perception on insulin use? As a nurse
we have to accept individual preferences and accept that patient as a human being
have the right to choose and have her own decision in regards to treatment plan. So,
whatever this study will reveal will all be valued.

This research is made to better understand patient with diabetes who needs
insulin treatment, what patient education can do that can change their decision for
better improvement of life and survival and not for promotion of any insulin producing
company.

3
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2241589/
Conceptual Paradigm

Respondent who refuse

Insulin Treatment

Administer ITAS
Questionnaire

Present Result to the

respondents

Educate the patient

Acceptance of Insulin Treatment ?

Yes/No

YES NO WHY
Statement of the Problem

This research attempts to determine the effects of patient education on the

decision making of patients who refuse insulin treatment.

The study specifically sought to answer the following questions;

1. What is the demographical profile of the selected T2DM in terms of:

1.1. Age;
1.2. Sex;
1.3. Educational Background;
1.4. Duration of disease condition;
1.5. Current medication;
1.6. Living condition; and
1.7. Monthly Income?

2. What are the common barriers perceived by the patient who requires insulin
treatment?

3. What are the barriers that affect patient’s decision –making in regards to insulin
treatment?

4. Would their decision change after giving health teaching?

5. What is the effect of patient education on the decision-making of selected T2DM

patient who refuse insulin treatment?
Scope, Limitation and Delimitation of the Study

The study took place at Pasig City Lifestyle Clinic, at Barangay, Malinao Pasig
City. A place located at the heart of Pasig because of its proximity along Pasig City Hall
and Pasig Mega Market. The clinic caters patient with lifestyle related diseases
including diabetes.

A sample of 40 insulin requiring T2DM patient able to read and write, with the
capacity to perform self injection, sound mind, in regardless of their demographical
profile such as age, sex, living condition, present medication, duration of disease
condition and monthly income . A purposive sampling were use through validation of six
month FBS result in which they obtain a fasting blood sugar result of 200mg/ml in 4-5
occasions, have 2-3 oral hyperglycemia medication and have been diagnosed diabetic
for 10 years and above. Exclusion for this study are those with life threatening disease
and gestational diabetes women. After signing of the informed consent and understand
fully the purpose of the study, the illegible respondent were given a 3 page
questionnaire.

The instruments consist of a self administered demographic and clinical data.

The 2 page questionnaire is the ITAS ( Insulin Treatment Appraisal Scale) a 20 item 5
point Likert Scale. For ease and convenience of the respondent it was also converted in
Tagalog version.

The answering took 20-30 minutes of which every patient were schedule for a
group session on patient education. Results of the ITAS will be revealed on the patient
for discussions.
Theoretical Framework

The study entitled, “The effect of patient education on the decision making
of selected T2DM who refuse insulin treatment utilized Imogene Kings “The theory of
Goal Attainment” ,which states that nursing is an interpersonal process of action,
reaction ,interaction and transaction whereby nurse and client share information about
their perception in the nursing situation. Human being is an open system constantly
interacting with her environment It includes personal, interpersonal and social system.

In this study, the assessment of data is collected using the questionnaire.

This will help the nurse to explore barriers on insulin use. Questionnaires were use
because it gives the client enough time to explore her own feelings, thus near real
answer will be revealed. Acc. to king in process of attaining goaI, the patient and nurse
each perceive, judge, and act, and together the patient and nurse react to each other
and interact with each other. After the data gathering and validation of answers the
nurse and the patient will work ways on how to work on with these barriers and
interaction will takes place. It will occur in the process of patient education and health
teaching. The barriers that are common and perceived by the patient will be the main
topics to be discussed. At the end of this process of communication and perceiving, if a
goal has been set a transaction is said to have occurred. The nurse and the patient also
decide on a way to work toward the goal that has been decided upon, and put into
action the plan that has been agreed upon. King believes that the main function of
nursing is to increase or to restore the health of the patient, so then, transactions should
occur to set goals related to the health of the patient. After transactions have occurred
and goals have been defined by the nurse and patient together, both parties work
toward the stated goals. This may involve interactions with other systems, such as other
healthcare workers, the patient's family, or larger systems.
Health Belief Model by Rosenstock, it is psychological model that attempts to
explain and predict health behaviors by focusing on the attitudes and beliefs of
individuals. The health belief model (HBM) has been found to be a useful and
applicable framework for the planning and implementation of programs to
encourage healthy behaviors.[23],[24] The use of the HBM framework and following
its components have been shown to be effective in achieving behavior change
and are strong factors for educational planning, implementing and evaluation