Effectiveness of an Insulin Therapy Education Intervention (ITEI) on Insulin Adherence among Patients with Type 2 Diabetes Mellitus: A Randomized Control Trial

The participants in this study are adults with type 2 Diabetes mellitus (T2DM) who have poor adherence towards insulin therapy. Participants must receive insulin therapy minimum for 1 year and need to attend sessions for ITEI health education module by a diabetes educator, need to give a 3ml blood sample (HbA1c) in the first weeks, 12th weeks and 24th weeks during this six-month duration of the study. There is a three-part session of the ITEI Module, which is parts 1, 2, and 3. all three parts will be incorporated into each session. Method delivery of this education intervention include physical (face to face) discussion/consultation involve demonstration, motivational interviewing, virtual consultation and provide interactive video and slide. All material include of slide and video been provided and designed for this study. All material go through the validation phase among 4 expertise person ( Endocrinologist, Dietitian, Diabetes Educator, family medicine specialist) in this endocrine fields. The content of education for this study call as Insulin Therapy Education Intervention (ITEI). The frequency of the session is once a months for the face to face session covering all the parts, Meanwhile within 2 weeks for the virtual consultation/ phone consultation for review self monitoring blood sugar and provide interactive video/slide. All session will be run individually and time is flexible according the patient availability time. Attendance will be monitored, if patient absent the next appointment will be reschedule. The strategy to monitored adherences is using questionnaire (Adherences Scale assessment) every 2 months. Part One: Part one will start with setting up the mutual agreement for care. A patient will be given a personal diary to list down the goal, methods to achieve the target, and reasons to be analysed if the target is not achieved. Health Education will be covered a topic on nine topics of health education that are currently used same with the control group (Diabetes, medication, diabetes emergency, exercises, footcare, self-monitoring blood glucose, wound care, insulin), diabetes distress, approaching and involving peer support to helping the client in managing diabetes. Part two: Part two of ITEI, the session will cover empowerment on diabetes self-care -motivational section session using Health belief model and Theories of Learning &Behaviourism to understand the content of health education that has been delivered, insulin injection technique demonstration and competency (practical section), lipodystrophy recognition, insulin storage practices, insulin adjustment/titration, a home task for self-monitoring blood glucose (SMBG), telephone consultation for any issued update, simple relaxation section technique base on the result of diabetes distress and Depression Anxiety Stress Scale (DASS). Lastly, the patient will be updating analysing personal diary targets based on a personal objective that has been set up before. Part Three: The last part of the ITEI module will be covering on problem-solving, stress management, planning intervention, and motivational section. Each education session will take minimally 30 minutes and a maximum of 2 hours for each activities/consultation. Telephone consultation will be taken within five to 10 minutes , however may be longer according to patient needs. Participant will be giving questionnaire on knowledge on insulin, adherence, diabetes distress and mental status (depression, anxiety, stress) and insulin injection technique competency as well as HbA1c will taking on pre (1st week), middle (12th week) and end (24th week).