Barriers to insulin initiation: the translating research into action for diabetes insulin starts project
Andrew J Karter, Usha Subramanian, Chandan Saha, Jesse C Crosson, Melissa M Parker, Bix E Swain, Howard H Moffet, David G Marrero, Andrew J Karter, Usha Subramanian, Chandan Saha, Jesse C Crosson, Melissa M Parker, Bix E Swain, Howard H Moffet, David G Marrero
Abstract
Objective: Reasons for failing to initiate prescribed insulin (primary nonadherence) are poorly understood. We investigated barriers to insulin initiation following a new prescription.
Research design and methods: We surveyed insulin-naïve patients with poorly controlled type 2 diabetes, already treated with two or more oral agents who were recently prescribed insulin. We compared responses for respondents prescribed, but never initiating, insulin (n = 69) with those dispensed insulin (n = 100).
Results: Subjects failing to initiate prescribed insulin commonly reported misconceptions regarding insulin risk (35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death), plans to instead work harder on behavioral goals, sense of personal failure, low self-efficacy, injection phobia, hypoglycemia concerns, negative impact on social life and job, inadequate health literacy, health care provider inadequately explaining risks/benefits, and limited insulin self-management training.
Conclusions: Primary adherence for insulin may be improved through better provider communication regarding risks, shared decision making, and insulin self-management training.
References
- Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, Zinman B. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2006;29:1963–1972
- Holman RR, Thorne KI, Farmer AJ, Davies MJ, Keenan JF, Paul S, Levy JC. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med 2007;357:1716–1730
- Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA 1999;281:2005–2012
- Brunton SA, Davis SN, Renda SM. Overcoming psychological barriers to insulin use in type 2 diabetes. Clin Cornerstone 2006;8(Suppl. 2):S19–S26
- Karter AJ, Parker MM, Moffet HH, Ahmed AT, Schmittdiel JA, Selby JV. New prescription medication gaps: a comprehensive measure of adherence to new prescriptions. Health Services Research 2009;44:1640–1661
- Leslie CA, Satin-Rapaport W. Psychological insulin resistance: a challenge for diabetes patients and health care professionals. J New Developments Clin Med 1995;13:21–27
- TRIAD Study Group. The Translating Research Into Action for Diabetes (TRIAD) Study: a multicenter study of diabetes in managed care. Diabetes Care 2002;25:386–389
- Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med 2004;36:588–594
- Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study: primary care evaluation of mental disorders: patient health questionnaire. JAMA 1999;282:1737–1744
- The American Association for Public Opinion Research. 2008. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 5th ed. Lenexa, Kansas;
- Polonsky WH, Fisher L, Guzman S, Villa-Caballero L, Edelman SV. Psychological insulin resistance in patients with type 2 diabetes: the scope of the problem. Diabetes Care 2005;28:2543–2545
- Larkin ME, Capasso VA, Chen CL, Mahoney EK, Hazard B, Cagliero E, Nathan DM. Measuring psychological insulin resistance: barriers to insulin use. Diabetes Educ 2008;34:511–517
- Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med 2003;163:83–90
- Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, Campbell R. Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med 2005;61:133–155
- Huang ES, Brown SE, Thakur N, Carlisle L, Foley E, Ewigman B, Meltzer DO. Racial/ethnic differences in concerns about current and future medications among patients with type 2 diabetes. Diabetes Care 2009;32:311–316
- Polonsky W. Psychological insulin resistance: the patient perspective. Diabetes Educ 2007;33(Suppl. 7):241S–244S
Source: PubMed