AACE: Why Physicians Delay the Start of Insulin in Type 2 Diabetes Patients

The perception that insulin therapy may be too burdensome for patients has led primary care physicians to delay the use of insulin therapy in patient with type 2 diabetes….

A report from this year’s American Association of Clinical Endocrinologist’s 22nd Annual Scientific & Clinical Congress found that 66% of those who responded in a survey of 71 primary care physicians thought the initiation of insulin therapy for their type 2 diabetes patients would be too overwhelming. Ninety-seven percent of the responding physicians from a hospital in Pennsylvania agreed that patients would be willing to use insulin if injections were not involved.

Kelly Khai Li Yap, M.D. and Yiyi Yan, M.D, Ph.D., with others, surveyed primary care physicians from the York Hospital to determine possible barriers to the initiation of insulin therapy. Using the hospital’s electronic medical records, a total of 1226 type 2 diabetic patients were identified: 273 identified patients had an HbA1C greater than 8.5% with 119 of these individuals not on insulin therapy. Seventy-one primary care physicians were then surveyed with a response rate of 45%.

Of those who responded, 88% believed that insulin is indeed efficacious in the management of type 2 diabetes. However, Yan reported that 69% of the responding physicians felt that their patients would perceive the initiation of insulin as a failure to control their blood glucose.

As to why primary care physicians feel this way, Yan reported, "We think concern about how they think their patients will react is the biggest barrier to initiating insulin."

Education is important not only for the patient but for their primary care provider as well. The authors reported that the more experienced providers were not only aware of treatment guidelines but were also more comfortable with using insulin in their patients. Providers who were less comfortable initiating insulin felt that more education was needed. Of those surveyed physicians, 60% had concerns that the insulin regimen was too complicated for their patients to follow. More than half of the responding primary care physicians felt that the various forms of insulin created confusion for prescribing.

From the results of their survey, Yan and colleagues concluded, "Our study suggests that education is the key to improving glycemic control and insulin usage among patients managed by their primary care physicians."

Yap K, et al "Barriers to insulin initiation in type 2 diabetes mellitus: A single institution study among the physicians" AACE 2013; Abstract 209