Barriers to insulin initiation: the translating research into action for diabetes insulin starts project.
OBJECTIVE
Reasons for failing to initiate prescribed insulin (primary nonadherence) are poorly understood. We investigated barriers to insulin initiation following a new prescription.


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.
Karter
Andrew J
AJ
Division of Research, Kaiser Permanente, Oakland, California, USA. andy.j.karter@kp.org
Subramanian
Usha
U
Saha
Chandan
C
Crosson
Jesse C
JC
Parker
Melissa M
MM
Swain
Bix E
BE
Moffet
Howard H
HH
Marrero
David G
DG
D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D055118:Medication Adherence / Q000523:psychology*; D016903:Drug Monitoring
D007004:Hypoglycemic Agents; D007328:Insulin