title: Rejection of insulin therapy among patients with type 2 diabetes in China: reasons and recommendations.
abstract: BACKGROUND
  Insulin injection therapy is one of the most effective treatments for type 2 diabetes mellitus (T2DM). Many people with T2DM in western countries resist starting insulin therapy; whether the same is true in China is unknown. This survey-based study assessed acceptance and rejection of insulin therapy among individuals with T2DM in China and self-reported reasons for these therapy choices. It also examined what methods may be useful for increasing the rate of insulin acceptance.
  
  
  METHODS
  A multi-center, cross-sectional survey was conducted between April and July 2010 to a convenience sample of inpatients and outpatients at 50 medical centers across 29 administrative divisions in China. Data were collected on sociodemographic and T2DM characteristics, therapy regime, and attitudes toward insulin therapy.
  
  
  RESULTS
  A total of 6 043 patients were surveyed, and 5 961 complete questionnaires (98.6%) were used in the analysis. Just over half the respondents (3 460, 58.0%) reported negative attitudes to insulin therapy, including 2 508 of the 4 469 patients (56.1%) whose physicians had recommended it to them. Of the patients counseled to use insulin, 800 (17.9%) were unwilling to start therapy and cited the following reasons: inconvenience (64.3%); concerns over addiction (24.6%); pain (14.3%); side effects (14.1%); and high cost (13.6%). Logistic regression suggested that respondents would be more willing to undertake insulin therapy if they had received diabetes education, had positive attitudes to the treatment, had higher glycosylated hemoglobin level, or had suffered diabetes for a longer period or with more complications.
  
  
  CONCLUSIONS
  Patients with T2DM in China are often resistant to insulin therapy if they have been diagnosed with the disease for a relatively short time or if the disease has been relatively mild. Educating patients on the benefits of insulin therapy, not only at the initial diagnosis with T2DM but also when insulin therapy becomes necessary, will likely increase their willingness to undertake it.
authors.affiliation: Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Xiong
authors.affiliation: Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China. Email: ylhxyy@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Yuan
authors.affiliation: Department of Endocrinology, First Hospital of Peking University, Beijing 100034, China.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Guo
authors.affiliation: Department of Health Education, Jiangsu Province Integrated Chinese and Western Medicine Hospital, Nanjing, Jiangsu 210028, China.
authors.forename: Qingqing
authors.initials: Q
authors.lastname: Lou
authors.affiliation: Department of Endocrinology, China-Japan Friendship Hospital, Beijing100029, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhao
authors.affiliation: Beijing Tsinghua Hospital, Beijing 102218, China.
authors.forename: Li
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Endocrinology of Peking University People's Hospital. Beijing 100034, China.
authors.forename: Mingxia
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Internal Medicine, Southeast University Zhongda Hospital, Nanjing, Jiangsu 210009, China.
authors.forename: Zilin
authors.initials: Z
authors.lastname: Sun
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
chemical_list: D007328:Insulin