INS and diabetes mellitus: A combination of factors ascribed to patients (e.g. fear of hypoglycaemia/injections, complex treatment regimen, polypharmacy), physicians (e.g. poor/ineffective communication, insufficient knowledge and support) or healthcare systems (e.g. lack of time/resource for physicians, lack of tools for patient/physician to monitor insulin titration, lack of medical coverage), may be particularly relevant in developing countries where development of infrastructure and capacity cannot cope with the rapid rate of increase in diabetes [36, 37].