Background Diabetes is one of the most prevalent disorders worldwide, necessitating serious interventions to prevent complications. The majority of patients have uncontrolled diabetes which could be linked to medication non-adherence. In the current setting many patients are receiving quadruple oral therapy due to refusal to receive insulin therapy.

Purpose To explore barriers to insulin adherence among patients with uncontrolled diabetes from the perspectives of the patients and their healthcare providers (pharmacists, physicians, nurses, health educators, social workers and nutritionists).

Material and methods The first phase of the study was investigating all barriers to medication adherence through semi-structured interviews with patients and their healthcare providers. The interview guide was created based on a conceptual model developed for the purpose of this study. Interviews were recorded, transcribed and analysed using a thematic content approach. A subgroup analysis of data focusing on insulin use was further conducted and recommendations for practice improvements were provided.

Results Thirty patients and healthcare providers were interviewed. Four main themes emerged from the subgroup analysis: lack of patient education (about the disease, the use of insulin, dose adjustments); phobia of insulin (side effects, addiction, self-injection, pain); environmental and cultural factors (working conditions, religious rituals, cost, travelling); and social stigma (rejected by people, lack of family support). Suggestions for practice improvements include educating the patient through an online portal created for diabetes, creating care plans which take the patient’s working conditions and religious rituals into account, creating a platform for educating the public to eliminate and correct myths about insulin use, and creating country-specific guidelines which take into consideration patients’ refusal of insulin and highlights the steps that should be followed by healthcare providers to convince the patient about the use of insulin or provide an evidence-based alternative approach to managing highly uncontrolled diabetes.

Conclusion There are many barriers that contribute to patients’ refusal of insulin use. Urgent interventions and policies need to be implemented to reduce diabetes complications and increase the awareness of the benefits of using insulin.

References and/or acknowledgements The authors thank all the pharmacists who were very supportive in the conduct of the study and all the participants who contributed to enriching our knowledge about their experiences.

No conflict of interest.