ADA: Diabetes Patients Resist
Starting Insulin Treatment
Half of patients with type 2 diabetes say they
are not willing to start insulin therapy if it
were necessary.
Dr. William Polonsky, from the University of
California, San Diego, and associates conducted
a survey of diabetes patients in an effort to
determine their willingness to take insulin if
it were prescribed. He presented results from
297 survey respondents at the 63rd Scientific
Sessions of the American Diabetes Association.
"Clinical lore suggests that patients with
type 2 diabetes are often reluctant to begin insulin
and may, in many cases, delay the onset of insulin
therapy for quite lengthy periods of time,"
Dr. Polonsky said. "Unfortunately, we know
very little about how common such 'psychological
insulin resistance' may be or why patients may
feel this way."
In the United Kingdom Prospective Diabetes Study,
of type 2 patients initially randomized to insulin
therapy, 27% refused. Also, early reports from
the International Diabetes Attitudes, Wishes and
Needs (DAWN) study indicate that 54.9% of a large
cohort of insulin-naive patients "worry about
the possibility of having to start insulin therapy."
Overall, 43.8% in the present study maintained
that they were willing or slightly willing to
take insulin if it were indicated. The majority
of patients (61.4%) said they were reluctant because
they felt that insulin therapy, once started,
could never be stopped. Also, 50.6% said that
they felt insulin would restrict their lives,
and 49.4% of patients said they were not confident
they could master the demands of insulin therapy.
The data also showed that more women than men
and more Hispanics than non-Hispanic whites were
unwilling to start insulin therapy. In particular,
Hispanics were more likely than non-Hispanic whites
to feel that insulin might cause long-term complications
and that injections would be too painful.
To increase insulin acceptance, brief personalized
interventions addressing the unique concerns of
patients need to be developed, Dr. Polonsky said.
Multiple barriers are typically present so clinicians
should be careful not to focus too heavily on
single fears alone. [Study title: Why Do Patients
Resist Insulin Therapy? Abstract 1811]
