Attitudes Toward Insulin Therapy

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Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study, by M. Peyrot and colleagues. Diabetes Care 28:2673-2679, 2005.

What is the problem and what is known about it so far?

Many patients with type 2 diabetes who could benefit from taking insulin do not receive it or do not receive it in a timely manner. This seems to be because some patients don’t want to take insulin and some health care providers don’t want to prescribe it. It may also be because some treatment guidelines recommend prescribing insulin only when other treatment options have failed.

Why did the researchers do this particular study?

To examine the attitudes of patients and health care providers toward insulin therapy.

How was the study done?

The researchers looked at responses from surveys completed by more than 2,000 patients with type 2 diabetes who were not taking insulin and by almost 4,000 diabetes care providers from 13 countries in Asia, Australia, Europe, and North America.

What did the researchers find?

Attitudes toward insulin therapy vary greatly from country to country. Patients don't think insulin is effective as other treatments and would blame themselves if they had to start taking insulin. Self-blame is much lower among those patients who stick to their diet and exercise plans and have fewer diabetes-related problems. Patients who are not managing their diabetes well are more likely to think of insulin therapy as something that will help them.

Most nurses and general practitioners don't prescribe insulin therapy until it is absolutely necessary. Specialists, however, don't wait that long. Delaying insulin therapy is less likely when physicians and nurses see that their patients have stuck with their treatment plans, think of insulin as being more effective than other treatments, and are less likely to delay the use of oral pills to treat diabetes.

What were the limitations of the study?

The results of this study showed associations, not causes.

Providers and patients in this study were not linked.

The study outcome is attitudes, and the researchers don't know how strongly they are related to patient and provider behaviors or clinical outcomes.

What are the implications of the study?

Both patients and health care providers seem resistant to insulin therapy. For providers, it seems to be a part of a larger pattern to delay prescribing any kind of medication to manage blood glucose levels. Guidelines to encourage the timely prescription of insulin therapy will need to address the reasons for why patients and health care providers are reluctant to use insulin therapy. Educational efforts should address the effectiveness and importance of insulin therapy for people with type 2 diabetes.

FOR MORE INFORMATION

Resource Guide 2005: Insulin

About Insulin and Other Drugs

101 Medication Tips for People With Diabetes, by Mary Anne Koda-Kimble, Betsy A. Carlisle, and Lisa Kroon (item no. 4833-01)