Insulin Prescribing Challenges and Physician-Suggested Interventions: Evidence From a Tertiary Care Hospital in Lahore, Pakistan.

BACKGROUND: Diabetes mellitus is a major global health challenge that is controlled through insulin therapy; however, its use is limited by several barriers. This study assessed physicians' perceptions of insulin use, associated barriers and suggested improvements in a tertiary care hospital in Lahore, Pakistan. METHODOLOGY: A cross-sectional survey was conducted at a tertiary care public sector hospital of Lahore, Pakistan, from September 2024 to February 2025. A total of 808 physicians participated. Data were collected through a questionnaire and analysed using descriptive and inferential statistics. Chi-square, Kruskal-Wallis, Bonferroni post hoc tests and binary logistic regression were applied using IBM SPSS Version 27. RESULTS: Among 808 physicians, 369 were males, and 439 were females. Most had 5-10 years of clinical experience, with medicine as the largest speciality. Common barriers to insulin therapy included patient resistance, hypoglycaemia, regimen complexity, cultural beliefs and limited resources. Male physicians were more likely to report barriers in both unadjusted and adjusted analyses (OR = 1.414, p = 0.015; AOR = 1.392, p = 0.024). MRCP-qualified physicians also had higher odds of reporting barriers (OR = 1.642, p = 0.034; AOR = 1.657, p = 0.042). Physicians with 5-10 years' experience were less likely to report barriers than those with < 5 years (OR = 0.557, p < 0.001; AOR = 0.588, p < 0.001). Physicians recommended that diabetes educators and regular follow-up can improve adherence. CONCLUSION: Major barriers to insulin therapy included patient resistance, inadequate education, cultural beliefs, financial constraints and fear of hypoglycaemia. Physicians emphasized the need for better patient education, regular follow-up and improved communication to enhance insulin adherence.