title: Willingness to initiate insulin among adults with type 2 diabetes in Australian primary care: Results from the Stepping Up Study.
abstract: OBJECTIVE
  To determine 'hypothetical willingness' to initiate insulin, and identify associated factors, among adults with type 2 diabetes (T2DM) in primary care for whom insulin is clinically indicated.
  
  
  METHODS
  Eligible participants were adults with T2DM with an HbA1c ≥7.5% (58mmol/mol) and prescribed maximum oral hypoglycaemic agents. A total of 261 participants were recruited from 74 Victorian general practices: mean age 62±10 years; 39% (n=103) women; diabetes duration 10±6 years; HbA1c 9.0±1.3% (75±14mmol/mol). Data collected by the Stepping Up Study: demographic and clinical characteristics, 'willingness' to initiate insulin, insulin appraisals, depressive symptoms, and diabetes-related distress. A multinomial regression investigated predictors of 'willingness'.
  
  
  RESULTS
  Nineteen percent (n=50) were 'very willing' to initiate insulin, if recommended. The final regression model (R(2)=.44, χ(2)(12) 145.91, p<.001) demonstrated higher socioeconomic status and less negative attitudes to insulin were associated with increased willingness to initiate insulin.
  
  
  CONCLUSIONS
  Among adults with T2DM for whom insulin is clinically indicated, only one in five are 'very willing' to begin insulin therapy. Independent of demographics, clinical factors and emotional wellbeing, insulin appraisals were associated with 'willingness'. This study highlights the importance of addressing attitudinal barriers to insulin therapy among adults with T2DM in primary care to improve insulin receptiveness.
authors.affiliation: The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia. Electronic address: etruscott@acbrd.org.au.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holmes-Truscott
authors.affiliation: Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton 3052, VIC, Australia; John Richards Initiative, Australian Institute of Primary Care and Ageing, La Trobe University, PO Box 821, Wodonga 3689, VIC, Australia. Electronic address: i.blackberry@latrobe.edu.au.
authors.forename: Irene
authors.initials: I
authors.lastname: Blackberry
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, 3065, VIC, Australia. Electronic address: dno@unimelb.edu.au.
authors.forename: David N
authors.initials: DN
authors.lastname: O'Neal
authors.affiliation: Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton 3052, VIC, Australia. Electronic address: j.furler@unimelb.edu.au.
authors.forename: John S
authors.initials: JS
authors.lastname: Furler
authors.affiliation: The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia; AHP Research, 16 Walden Way, Hornchurch RM11 2LB, United Kingdom. Electronic address: jspeight@acbrd.org.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003657:Decision Making; D003863:Depression / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology*; D004358:Drug Therapy / Q000523:psychology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Insulin therapy; Primary care; Type 2 diabetes