title: Delay of insulin initiation in patients with type 2 diabetes mellitus inadequately controlled with oral hypoglycemic agents (analysis of patient- and physician-related factors): A prospective observational DIPP-FACTOR study in Korea.
abstract: OBJECTIVE
  To assess the time to initiation of insulin therapy, and concurrently investigate both patient- and physician-related factors associated with delaying insulin therapy in Korean patients with type 2 diabetes uncontrolled by oral hypoglycemic agents (OHAs).
  
  
  METHODS
  This prospective, observational disease registry study was carried out across 69 centers in Korea. Type 2 diabetes patients who had received two or more OHAs within the past 5 years, had a glycated hemoglobin ≥8% in the past 6 months and had not received insulin were included. Data recorded on data collection forms during a 12-month period were analyzed.
  
  
  RESULTS
  Of 2168 patients enrolled, 1959 were evaluated and classified as the insulin-initiated or insulin-delayed group. Insulin was prescribed for just 20% of the patients during a 1-year follow-up period, and less than half (44.5%) of the patients who were taking two OHAs started insulin after 6 years. Patient-related factors for delay in insulin initiation included older age, shorter duration of diabetes and lower glycated hemoglobin. Physician-related factors included age (~50 to <60 years), sex (women) and number (<1000) of patients consulted per month. Patient refusal (33.6%) and physicians' concerns of patient non-compliance (26.5%) were the major physician-reported reasons for delaying insulin therapy. Inconvenience of insulin therapy (51.6%) and fear of injection (48.2%) were the major reasons for patient refusal.
  
  
  CONCLUSIONS
  Insulin initiation is delayed in patients with type 2 diabetes uncontrolled by two or more OHAs in Korea. Patient- and physician-related factors associated with this delay need to be addressed for better diabetes management.
authors.affiliation: Division of Endocrinology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Sin Gon
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Division of Endocrinology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Nam Hoon
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Bon Jeong
authors.identifier: http://orcid.org/0000-0002-3414-8949
authors.initials: BJ
authors.lastname: Ku
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Shon
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: Doo Man
authors.initials: DM
authors.lastname: Kim
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
authors.forename: Tae Sun
authors.initials: TS
authors.lastname: Park
authors.affiliation: Division of Endocrinology & Metabolism, Department of Internal Medicine, Inha University Incheon, Incheon, Korea.
authors.forename: Yong-Seong
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
authors.forename: In Joo
authors.initials: IJ
authors.lastname: Kim
authors.affiliation: Division of Endocrinology, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Dong Seop
authors.initials: DS
authors.lastname: Choi
mesh_terms: D000284:Administration, Oral; D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Insulin therapy; Physician and patient behaviors; Type 2 diabetes