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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]