In Europe, a comparatively lower PIR prevalence of 42.5% was reported in a study among patients with poorly controlled type 2 diabetes in East London.16 The high prevalence of PIR in our study may be because of a weak integration of diabetes care at the primary care level, misinformation and inadequate training of patients with diabetes mellitus on disease process, progression, complications, indications and benefits of insulin therapy. Here, INS is linked to diabetes mellitus.