Quality of life of insulin dependent diabetic patients who do not have access to insulin pens: a cross-sectional study from Palestine

Diabetic patients' numbers are increasing around the world, this metabolic disease affects patient's quality of life in all domains: physically, socially, psychologically and emotionally. As the disease progresses patients need to use insulin. According to the Palestinian MOH (Ministry of Health) 12% of people in Palestine have diabetes. Twenty percent of type 2 dia-betic patients visit the MOH clinics and use insulin also 12% use both insulin and oral drugs to control their blood glucose levels. These patients administer insulin subcutaneously by vial and syringe. The aim of this study was to assess QoL (quality of life) of diabetic patients us-ing insulin, factors affecting it, preference of patients to use insulin pen and their willingness to pay for them. Method: A descriptive study conducted with a sample of 311 diabetic pa-tients that use vial/syringe to administer insulin and attending MOH diabetic clinics in Bethle-hem and Hebron. A questionnaire was designed to assess four parts; socio-demographic part, patient's health profile, QoL part and willingness to pay for insulin pens part. QoL was meas-ured using SF-36v2® questionnaire and the willingness to pay part validated using pilot study. Results were analyzed using Quality Metric Health Outcomes™ Scoring Software 4.0 and SPSS software. Results and conclusion: The mean scores of QoL domains ranged from 40.7 to 65.6. Diabetic patients had lower scores than general population in all domains of QoL; physical functioning, role-physical, body pain, general health, vitality, role-emotional, mental health, physical composite summary and mental composite summary, except in social functioning. The majority of participants had lower scores than general population in all QoL domains. The results revealed that gender, age and glycemic control, number of family mem-bers, duration of insulin use had no significant impact on QoL. Approximately 77% of partic-ipants reported having complications, which had a significant negative effect on their QoL (P-value < 0.001 in all domains). Single patients and patients living in Hebron had a significant positive effect on QoL. Higher level of education, high monthly income and being employed had a positive effect on QoL while longer duration of diabetes had negative effect. Eighty-five percent of participants preferred to use insulin pens if it was available as a choice in the MOH; 35% of them were willing to pay extra money to get insulin pens instead of vi-al/syringe. This study revealed that the QoL of diabetic patients using insulin in this sample was low, which could be increased if the government included insulin pens in the MOH drug list.