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Diabetes Care. 2010 Apr;33(4):733-5. doi: 10.2337/dc09-1184. Epub 2010 Jan 19.

Barriers to insulin initiation: the translating research into action for diabetes insulin starts project.

Author information

  • 1Division of Research, Kaiser Permanente, Oakland, California, USA. andy.j.karter@kp.org

Abstract

OBJECTIVE:

Reasons for failing to initiate prescribed insulin (primary nonadherence) are poorly understood. We investigated barriers to insulin initiation following a new prescription.

RESEARCH DESIGN AND 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.

PMID:
20086256
[PubMed - indexed for MEDLINE]
PMCID:
PMC2845015
Free PMC Article
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