• Alan Abdullah Abdulrahman Department of Paediatrics, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.




Type I Diabetes Mellitus, Blood glucose monitoring, Insulin adherence therapy, Sulaimani, Diabetic ketoacidosis



Type 1 diabetes mellitus is a chronic condition in the paediatric age group. Its treatment is always challenging for the affected child, the whole family, and the health care system. Reasonable control is usually the aim because it will prevent or delay the complications of diabetes. Adherence to insulin therapy is among the essential factors in the control of the disease.


To identify factors that influence insulin adherence in children with Type 1 diabetes mellitus.

Patients and Methods

A cross-section study was done among type 1 diabetic children who have been registered in the diabetic centre in Dr Jamal Ahmed Rashid Paediatric Teaching Hospital from April 1st to September 30th, 2018. 

All the affected 104 cases were below 16 years of age. Caretakers of the patient were interviewed using pretested questionnaires to provide information on socio-demographic characteristics. Insulin adherence was measured by the 8-Item Morisky Medication Adherence Scale (MMAS); furthermore, injection-related barriers to insulin injection were assessed.


The mean age (±SD) of the 104 affected diabetic children was 7.07 ± 3.36 years. The male-to-female ratio was 1.04:1 (53 males and 51 females). Good adherence was found in 72.1% of the cases, 19.2% had an average adherence, with 8.7% were poorly adherent to therapy.


Most type 1 diabetic children had good adherence to insulin therapy with fair 1-2 blood glucose test monitoring per day. Family supervision of the insulin injections and blood sugar monitoring were the two significant factors in insulin adherence.


Ramin A, Omar A, The endocrine system. Diabetes mellitus in children. In: Behrman R E, Kliegman R M, Jenson H B, eds. Nelson Textbook of Pediatrics. 19th edition. Philadelphia, WB Saunders; 2011. p. 1968 – 1997. DOI: https://doi.org/10.1016/B978-1-4377-0755-7.00583-2

Samuel S, PharmD, Michel A.K, Neil W, and Tami W. A Systematic Review of Insulin Adherence Measures in Patients with Diabetes. Journal of Managed Care & Specialty Pharmacy JMCP. 2016;22(11): 1224-46. DOI: https://doi.org/10.18553/jmcp.2016.22.11.1224

Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltesz G, EURODIAB study group. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet. 2009;373 (9680):2027–2033. DOI: https://doi.org/10.1016/S0140-6736(09)60568-7

Khalid H. S. Factors Affecting Glycemic Control in Type 1 Diabetes Mellitus among Children in Sulaimani Governorate, Iraq. Int J Med Invest 2019;8(2): 40-49.

Lynne L L, MD, Madhusmita M, MD, MPH. Insulin therapy for children and adolescents with type 1 diabetes mellitus. [Internet]. Update. 2020. Available from: https://www.uptodate.com/contents/insulin-therapy-for-children-and-adolescents-with-type-1-diabetes-mellitus#H108402781. Accessed March 30th, 2020.

Shadi F , Mania R , Zahra H , Farzaneh A , Mostafa Q. Insulin adherence in patients with diabetes: Risk factors for injection omission, Prim. Care Diab. 2014;8(4):338-345. DOI: https://doi.org/10.1016/j.pcd.2014.03.001

Janet S, Georgeanna K, Kenneth C, Leslie P, Francine K, Lori R et al. Care of Children and Adolescents With Type 1 Diabetes. Diabetes Care 2005 Jan; 28 (1):186-212. DOI: https://doi.org/10.2337/diacare.28.1.186

Sabaté, Eduardo & World Health Organization. Noncommunicable Diseases and Mental Health Cluster. [Internet]. (‎2001)‎ Adherence to long-term therapies: policy for action: WHO; meeting report, 4-5 June 2001. World Health Organization. Available from: https://apps.who.int/iris/handle/10665/66984. Accessed April 1st, 2020.

Paloma A-V, Josefa P R, K. Walkiria Z C, David R de la Parra, Janneth B C, Francisco J. G-P. Factors Associated with Insulin Nonadherence in Type 1 Diabetes Mellitus Patients in Mexico. Int J Diabetes Metab 2019; 25:139–147. DOI: https://doi.org/10.1159/000502903

Chong L Y, Noraida M S, Adherence to insulin treatment in children with type I Diabetes mellitus at a hospital in Malaysia. Asian J Pharm Clin Res 2017; 10(11):356-361. DOI: https://doi.org/10.22159/ajpcr.2017.v10i11.20130

Joseph P. H. M, Adam M. R, Alana R. F, Sarah E. R, and Gary R. G. Contributing Factors to Poor Adherence and Glycemic Control in Pediatric Type 1 Diabetes: Facilitating a Move toward Telehealth. In: Prof. Chih-Pin Liu, editor. Type 1 Diabetes - Complications, Pathogenesis, and Alternative Treatments. 1st edition. Intech; 2011. P. 141-158.

Musarrat R, Abdul B, Asher F, Muhammad Y A, Zahara A R. Factors associated with non-adherence to insulin in patients with Type-1 diabetes. Pak J Med Sci. 2014; 30(2): 233-239.

Catherine K, Nicholas M. Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda. Dov Press journal: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2018;11: 93–104. DOI: https://doi.org/10.2147/DMSO.S156858

Pantip S, Rossamalin C, and Rungpetch C. Psychometric Properties of the Thai version of the 8-item Morisky Medication Adherence Scale in Patients with Type 2 Diabetes. The Annals of Pharmacotherapy 2009 May;43: 950-7. DOI: https://doi.org/10.1345/aph.1L453

Gomes M, Negrato C. Adherence to therapeutic insulin regimens in patients with type 1 diabetes. A nationwide survey in Brazil. Diabetes research and clinical practice. 2016;120:47-55. DOI: https://doi.org/10.1016/j.diabres.2016.07.011

Hassan K, Heptulla RA. Glycemic control in pediatric type 1 diabetes: role of caregiver literacy. Paediatrics. 2010 May;125(5):e1104-8. DOI: https://doi.org/10.1542/peds.2009-1486

Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. Jama. 2002;288(4):475-82. DOI: https://doi.org/10.1001/jama.288.4.475

Dalia A, Arwa KH A, Shroouk KH M, Layla M M, Basayer M M, Wegdan M A, et al. Factors are contributing to non-adherence to insulin therapy among type 1 and type2 diabetes mellitus patients in Asser region, Saudi Arabia. Biomedical Research 2018; 29(10): 2090-2095. DOI: https://doi.org/10.4066/biomedicalresearch.29-18-503

Davies M, Gagliardino JJ, Gray L, Khunti K, Mohan V, Hughes R. Real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: a systematic review. Diabetic Medicine. 2013;30(5):512-24. DOI: https://doi.org/10.1111/dme.12128

DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health psychology. 2004;23(2):207. DOI: https://doi.org/10.1037/0278-6133.23.2.207

Lewandowski A, Drotar D. The relationship between parent-reported social support and adherence to medical treatment in families of adolescents with type 1 diabetes. Journal of Pediatric Psychology. 2006;32(4):427-36. DOI: https://doi.org/10.1093/jpepsy/jsl037

Pereira MG, Berg-Cross L, Almeida P, Machado JC. Family environment and support impact on adherence, metabolic control, and quality of life in adolescents with diabetes. International journal of behavioural medicine. 2008;15(3):187-93. DOI: https://doi.org/10.1080/10705500802222436

Miller TA, DiMatteo MR. Importance of family/social support and impact on adherence to diabetic therapy. Diabetes, metabolic syndrome, and obesity: targets and therapy. 2013; 6:421. DOI: https://doi.org/10.2147/DMSO.S36368



How to Cite

Abdulrahman A. FACTORS ASSOCIATED WITH INSULIN ADHERENCE IN TYPE 1 DIABETIC CHILDREN ATTENDING JAMAL AHMED RASHID PAEDIATRIC TEACHING HOSPITAL IN SULAIMANIA CITY. JSMC [Internet]. 2021 Dec. 21 [cited 2024 Jun. 21];11(4):469-76. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10333

Similar Articles

1-10 of 415

You may also start an advanced similarity search for this article.