Self-management of insulin therapy among people with diabetes
DOI:
https://doi.org/10.36517/2175-6783.20262797029Keywords:
Diabetes Mellitus; Insulin; Self-Management; Primary Health Care; Qualitative Research.Abstract
Objective: to understand insulin therapy self-management among people with diabetes receiving Primary Health Care. Methods: we conducted a qualitative study with 60 people with diabetes using insulin. Data were collected through semi-structured interviews and field notes and analyzed using interpretive description, with IRaMuTeQ supporting lexical exploration. The analysis yielded three analytical categories. Results: participants’ accounts portrayed insulin therapy self-management as a complex, dynamic process shaped by emotional, social, and structural dimensions. Insulin initiation was marked by fear, resistance, distress, and perceived disease progression but was gradually reframed as a means of managing the condition and gaining autonomy. Everyday practices involved negotiations among treatment recommendations, eating practices, blood glucose monitoring, physical activity, and therapeutic adjustments. Participants also reported gaps in guidance, lack of confidence in administering insulin, and dependence on family members and health care professionals. Conclusion: insulin therapy selfmanagement requires more than technical proficiency and depends on ongoing person-centered educational, emotional, and social support responsive to everyday circumstances. Contributions to practice: the findings underscore the need to strengthen nurses’ role in health education, longitudinal follow-up, and support for autonomy among people with diabetes receiving Primary Health Care.
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1. Hasankhani MB, Mirzaei H, Karamoozian A. Global trend analysis of diabetes mellitus incidence, mortality, and mortality-to-incidence ratio from 1990 to 2019. Sci Rep. 2023;13(1):21908. doi: https://doi.org/10.1038/s41598-023-49249-0
2. Hossain MJ, Al-Mamun M, Islam MR. Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused. Health Sci Rep. 2024;7(3):e2004. doi: https://dx.doi.org/10.1002/hsr2.2004
3. Tegegne KD, Gebeyehu NA, Yirdaw LT, Yitayew YA, Kassaw MW. Determinants of poor glycemic control among type 2 diabetes in Ethiopia: a systematic review and meta-analysis. Front Public Health. 2024;12:1256024. doi: https://doi.org/10.3389/fpubh.2024.1256024
4. Bitew ZW, Alemu A, Jember DA, Tadesse E, Getaneh FB, Sied A, et al. Prevalence of glycemic control and factors associated with poor glycemic control: a systematic review and meta-analysis. Inquiry. 2023;60:469580231155716. doi: https://doi.org/10.1177/00469580231155716
5. Genitsaridi I, Salpea P, Salim A, Sajjadi SF, Tomic D, James S, et al. 11th edition of the IDF Diabetes Atlas: global, regional, and national diabetes prevalence estimates for 2024 and projections for 2050. Lancet Diabetes Endocrinol. 2026;14(2):149-56. doi: http://doi.org/10.1016/S2213-8587(25)00299-2
6. Parker ED, Lin J, Mahoney T, Ume N, Yang G, Gabbay RA, et al. Economic costs of diabetes in the U.S. in 2022. Diabetes Care. 2024;47(1):26-43. doi: doi: https://doi.org/10.2337/dci23-0085
7. Borrelli EP. Estimating the annual cost burden of diabetic peripheral neuropathy in the United States. Endocrine. 2025;90(1):60-5. doi: https://doi.org/10.1007/s12020-025-04318-4
8. McGill JB, Hirsch IB, Parkin CG, Aleppo G, Levy CJ, Gavin JR. The current and future role of insulin therapy in the management of type 2 diabetes: a narrative review. Diabetes Ther. 2024;15(5):1085-98. doi: https://dx.doi.org/10.1007/s13300-024-01569-8
9. Yokoyama H, Araki SI, Yamazaki K, Kawai K, Shirabe SI, Oishi M, et al. Trends in glycemic control in patients with insulin therapy compared with non-insulin or no drugs in type 2 diabetes in Japan: a long-term view of real-world treatment between 2002 and 2018 (JDDM 66). BMJ Open Diabetes Res Care. 2022;10(3):e002727. doi: https://doi.org/10.1136/bmjdrc-2021-002727
10. Leon C, Crowley C, Hogan H, Jani YH. Exploring the complexity of safe insulin management during transfer of care using qualitative methods. Diabet Med. 2025;42(8):e70054. doi: https://dx.doi.org/10.1111/dme.70054
11. Fonseca LM, Schmidt JJ, Snoek FJ, Weinstock RS, Chaytor N, Stuckey H, et al. Barriers and facilitators of self-management in older people with type 1 diabetes: a narrative review focusing on cognitive impairment. Diabetes Metab Syndr Obes. 2024;17:2403-17. doi: https://doi.org/10.2147/DMSO.S410363
12. Rodriguez P, San Martin VT, Pantalone KM. Therapeutic inertia in the management of type 2 diabetes: a narrative review. Diabetes Ther. 2024; 15(3):567-83. doi: https://dx.doi.org/10.1007/s13300-024-01530-9
13. Tolentino DA, Boy P, Long SN, Roca RPE, Peña M, Palao GMG, et al. Navigating type 2 diabetes care: Asian American perspectives on self-management education and support. Sci Diabetes Self Manag Care. 2025;51(3):225-40. doi: https://doi.org/10.1177/26350106251337487
14. Mourão DM, Santos GMS, Duarte GC. Enhancing diabetes self-management through the AADE7 self-care behaviors framework: an observational study. Einstein (São Paulo). 2025;23:eAO1213. doi: https://dx.doi.org/10.31744/einstein_journal/2025AO1213
15. Landu ZK, Crowley T. Primary health care nurses’ knowledge, self-efficacy and performance of diabetes self-management support. Afr J Prim Health Care Fam Med. 2023;15(1):e1-7. doi: https://doi.org/10.4102/phcfm.v15i1.3713
16. Yimer YS, Ahmed AA, Addissie A, Kidane EG, Reja A, Abdela AA. Patients and healthcare providers needs and challenges in diabetes self-management and support in Ethiopian primary healthcare context. BMC Health Serv Res. 2025;25(1):774. doi: http://doi.org/10.1186/s12913-025-12953-w
17. Schulman-Green D, Jaser S, Martin F, Alonzo A, Grey M, McCorkle R, et al. Processes of self-management in chronic illness. J Nurs Scholarsh. 2012; 44(2):136-44. doi: https://dx.doi.org/10.1111/j.1547-5069.2012.01444.x
18. Thorne S, Stephens J, Truant T. Building qualitative study design using nursing’s disciplinary epistemology. J Adv Nurs. 2016;72(2):451-60. doi: https://doi.org/1111/jan.12822
19. Guldemond N. What is meant by ‘integrated personalized diabetes management’: a view into the future and what success should look like. Diabetes Obes Metab. 2024;26(Suppl. 1):14-29. doi: https://doi.org/10.1111/dom.15476
20. Woodward A, Walters K, Davies N, Nimmons D, Protheroe J, Chew-Graham CA, et al. Barriers and facilitators of self-management of diabetes amongst people experiencing socioeconomic deprivation: a systematic review and qualitative synthesis. Health Expect. 2024;27(3):e14070. doi: https://doi.org/10.1111/hex.14070
21. Diviani N. Self-management. In: Bennett G, Goodall E. The Palgrave Encyclopedia of Disability. Cham: Springer Nature Switzerland; 2025. doi: https://doi.org/10.1007/978-3-031-40858-8_441-1
22. Puzhakkal S, Kavanagh S, Conway B, Kow CS, Hasan SS. Self-care and self-management in diabetes: concepts, theories and practices. Int J Clin Pharm. 2025;47(6):2094-100. doi: https://dx.doi.org/10.1007/s11096-025-01941-z
23. Liu C, Roza J, Ooi CW, Mathew BK, Elya, Tang WE. Impact of patients’ beliefs about insulin on acceptance and adherence to insulin therapy: a qualitative study in primary care. BMC Prim Care. 2022;23(1):15. doi: https://dx.doi.org/10.1186/s12875-022-01627-9
24. Cleves-Valencia JJ, Roncancio-Moreno M, Picione RL. Beyond Therapeutic Adherence: Alternative Pathways for Understanding Medical Treatment in Type 1 Diabetes Mellitus. Int J Environ Res Public Health. 2024;21(3):320. doi: https://dx.doi.org/10.3390/ijerph21030320
25. Lemos CA, Gonçalves AMRF, Vieira EM, Pereira LRL. Learning demands of diabetes self-management: a qualitative study with people who use insulin. Rev Latino-Am Enfermagem. 2024;32:e4167. doi: https://doi.org/10.1590/1518-8345.6963.4167
26. Potter DA. Biographical disruption, redefinition, and recovery: Illness identities of women with depression and diabetes. Health. 2024;28(6):918-36. doi: http://doi.org/10.1177/13634593231213773
27. Andrade RC, Campos HLM, Alves TF, Braga JAC, Dantas ENT, Leon EB. Perception of diabetic users about self-care for their feet: a qualitative analysis. Cogitare Enferm. 2024;29:e92149. doi: https://doi.org/10.1590/ce.v29i0.92149
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The dataset supporting the findings of this study will be available from the corresponding author upon reasonable request.
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Copyright (c) 2026 Lourena Ferreira dos Reis Campos, José Claudio Garcia Lira Neto, Maria Augusta Rocha Bezerra, Ítalo Arão Pereira Ribeiro, Ruth Cardoso Rocha, Jéssica de Menezes Nogueira, Mychelangela de Assis Brito
This work is licensed under a Creative Commons Attribution 4.0 International License.
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