title: Barriers to insulin initiation: the translating research into action for diabetes insulin starts project.
abstract: 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.
authors.affiliation: Division of Research, Kaiser Permanente, Oakland, California, USA. andy.j.karter@kp.org
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Usha
authors.initials: U
authors.lastname: Subramanian
authors.forename: Chandan
authors.initials: C
authors.lastname: Saha
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Crosson
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Parker
authors.forename: Bix E
authors.initials: BE
authors.lastname: Swain
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
mesh_terms: 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
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin