Why Don't People Take Their Insulin as Prescribed?

The purpose of this study was to assess factors associated with patient frequency of intentionally skipping insulin injections, according to researcher Mark Peyrot, PhD. 

Data were obtained through an internet survey of 502 U.S. adults self-identified as taking insulin by injection to treat Type 1 or Type 2 diabetes. Multiple regression analysis assessed independent associations of various demographic, disease, and injection-specific factors with insulin omission.

Intentional insulin omission was reported by more than half of respondents; regular omission was reported by 20%. Risk factors differed between Type 1 and Type 2 diabetic patients, with diet nonadherence more prominent in Type 1 diabetes and age, education, income, pain, and embarrassment more prominent in Type 2 diabetes.   It is not surprising that non-compliance in Type 1 diabetes patients was associated with poor eating habits. The researchers found that younger age, lower income, and embarrassment were the most important factors for poor compliance in people with Type 2 diabetes. 

Whereas most patients did not report regular intentional omission of insulin injections, a substantial number did. The findings suggest that it is important to identify patients who intentionally omit insulin and be aware of the potential risk factors identified here. For patients who report injection-related problems (interference with daily activities, injection pain, and embarrassment), providers should consider recommending strategies and tools for addressing these problems to increase adherence to prescribed insulin regimens. This could improve clinical outcomes. Although the results address the needed educational intervention, especially when it comes to embarrassment, pain, and interference with activities, it also points to the fact that healthcare teams need to talk with patients before this becomes a common practice, rather than a single occurrence.

Diabetes Care, Feb. 2011