title: Barriers to the initiation of, and persistence with, insulin therapy.
abstract: OBJECTIVE
  Many patients with Type 2 diabetes mellitus (DM) delay and/or discontinue the use of insulin. This study determined patient-perceived barriers to the initiation of, and persistence with, insulin therapy.
  
  
  METHODS
  Patients > or = 18 years with Type 2 DM and > or = 1 elevated HbA(1c) test result (> or = 9%) were identified from computerized laboratory test results within a single healthcare system, a study limitation. Insulin use patterns were characterized by automated pharmacy claims data, and patients were classified into those who discontinued insulin use (discontinuers) or those who did not initiate insulin use (non-initiators). Telephone interviews were conducted to determine the barriers to initiation of, and persistence with, insulin therapy.
  
  
  RESULTS
  Response rates were 80.0% (73/91) for discontinuers and 82.0% (129/157) for non-initiators. Pharmacy claims data indicated that discontinuers stopped filling prescriptions for insulin; 46.6% of patients self-reported discontinuing insulin. The average time between first and last prescription for insulin among discontinuers was 4.9 years (SD = 4.4). The most common reasons for discontinuation were related to insulin injection (74.0%) and a doctor's advice not to use insulin (47.1%). In the non-initiator group, 86.1% were never advised by a healthcare provider to take insulin.
  
  
  CONCLUSIONS
  These findings suggest that issues related to insulin injection are the primary reason patients with Type 2 DM discontinue insulin therapy. Understanding these patterns is important to develop interventions to overcome barriers to treatment and improve the medical outcomes of patients with Type 2 DM.
authors.affiliation: Weill Medical College of Cornell University, New York, NY, USA. susano@episource.org
authors.forename: Susan A
authors.initials: SA
authors.lastname: Oliveria
authors.forename: Laura A
authors.initials: LA
authors.lastname: Menditto
authors.forename: Marianne
authors.initials: M
authors.lastname: Ulcickas Yood
authors.forename: Yuri H
authors.initials: YH
authors.lastname: Koo
authors.forename: Karen E
authors.initials: KE
authors.lastname: Wells
authors.forename: Bruce D
authors.initials: BD
authors.lastname: McCarthy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D010361:Patients / Q000523:psychology*
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human