Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study

Abstract

Aims: To examine patient and physician beliefs regarding insulin therapy and the degree to which patients adhere to their insulin regimens.

Methods: Internet survey of 1250 physicians (600 specialists, 650 primary care physicians) who treat patients with diabetes and telephone survey of 1530 insulin-treated patients (180 with Type 1 diabetes, 1350 with Type 2 diabetes) in China, France, Japan, Germany, Spain, Turkey, the UK or the USA.

Results: One third (33.2%) of patients reported insulin omission/non-adherence at least 1 day in the last month, with an average of 3.3 days. Three quarters (72.5%) of physicians report that their typical patient does not take their insulin as prescribed, with a mean of 4.3 days per month of basal insulin omission/non-adherence and 5.7 days per month of prandial insulin omission/non-adherence. Patients and providers indicated the same five most common reasons for insulin omission/non-adherence: too busy; travelling; skipped meals; stress/emotional problems; public embarrassment. Physicians reported low patient success at initiating insulin in a timely fashion and adjusting insulin doses. Most physicians report that many insulin-treated patients do not have adequate glucose control (87.6%) and that they would treat more aggressively if not for concern about hypoglycaemia (75.5%). Although a majority of patients (and physicians) regard insulin treatment as restrictive, more patients see insulin treatment as having positive than negative impacts on their lives.

Conclusions: Glucose control is inadequate among insulin-treated patients, in part attributable to insulin omission/non-adherence and lack of dose adjustment. There is a need for insulin regimens that are less restrictive and burdensome with lower risk of hypoglycaemia.

© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Figures

FIGURE 1

Physician report: patient success with insulin treatment tasks (n = 1250)*†. *Percentage of physicians reporting that their patients are very successful (vs. somewhat successful, not very successful, not at all successful, ‘don’t know’). †Specialists and primary care physicians not significantly different for any measure

FIGURE 2

Patient reports: impact of insulin treatment on life domains in patients with Type 1 (non-hatched) and Type 2 (hatched) diabetes mellitus (n = 1530). *Positive and negative responses differ significantly (P < 0.05); †reports from patients with Type 1 and Type 2 diabetes differ significantly (P < 0.05).

FIGURE 3

Physician beliefs about insulin treatment (n = 1250). *Strongly agree or somewhat agree (vs. strongly disagree, somewhat disagree, neither, ‘don’t know’); †strongly agree or somewhat agree (vs. strongly disagree, somewhat disagree)