title: Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study.
abstract: OBJECTIVE
  To examine the correlates of patient and provider attitudes toward insulin therapy.
  
  
  METHODS
  Data are from surveys of patients with type 2 diabetes not taking insulin (n = 2,061) and diabetes care providers (nurses = 1,109; physicians = 2,681) in 13 countries in Asia, Australia, Europe, and North America. Multiple regression analysis is used to identify correlates of attitudes toward insulin therapy among patients, physicians, and nurses.
  
  
  RESULTS
  Patient and provider attitudes differ significantly across countries, controlling for individual characteristics. Patients rate the clinical efficacy of insulin as low and would blame themselves if they had to start insulin therapy. Self-blame is significantly lower among those who have better diet and exercise adherence and less diabetes-related distress. Patients who are not managing their diabetes well (poor perceived control, more complications, and diabetes-related distress) are significantly more likely to see insulin therapy as potentially beneficial. Most nurses and general practitioners (50-55%) delay insulin therapy until absolutely necessary, but specialists and opinion leaders are less likely to do so. Delay of insulin therapy is significantly less likely when physicians and nurses see their patients as more adherent to medication or appointment regimens, view insulin as more efficacious, and when they are less likely to delay oral diabetes medications.
  
  
  CONCLUSIONS
  Patient and provider resistance to insulin therapy is substantial, and for providers it is part of a larger pattern of reluctance to prescribe blood glucose-lowering medication. Interventions to facilitate timely initiation of insulin therapy will need to address factors associated with this resistance.
authors.affiliation: Department of Sociology, Loyola College, Baltimore, MD 21210-2699, USA. mpeyrot@loyola.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Peyrot
authors.forename: Richard R
authors.initials: RR
authors.lastname: Rubin
authors.forename: Torsten
authors.initials: T
authors.lastname: Lauritzen
authors.forename: Soren E
authors.initials: SE
authors.lastname: Skovlund
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Snoek
authors.forename: David R
authors.initials: DR
authors.lastname: Matthews
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Landgraf
authors.forename: Line
authors.initials: L
authors.lastname: Kleinebreil
mesh_terms: D000328:Adult; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D009726:Nurses / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D016079:Refusal to Treat / Q000706:statistics & numerical data*; D012044:Regression Analysis; D016312:Treatment Refusal / Q000706:statistics & numerical data*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin