3 actions may help reluctant patients begin insulin therapy for type 2 diabetes

Patients' perceived helpfulness of certain actions by health care professionals was linked to earlier insulin initiation and greater insulin continuation over time, a survey found.


Demonstrating the injection process, explaining insulin benefits, and adopting a collaborative style may help clinicians and other health care professionals facilitate insulin therapy initiation in patients who are reluctant to begin basal insulin, an international study found.

Between December 2016 and August 2017, researchers surveyed 594 adults (mean age, 53.3 years; 57% men) with type 2 diabetes (mean time since diagnosis, 8.2 years) who reported initial reluctance to but eventually started insulin therapy. Patients were from seven countries: Brazil (n=35), Canada (n=74), Germany (n=75), Japan (n=99), Spain (n=66), the U.K. (n=125), and the U.S. (n=120). The survey included 38 possible health care professional actions, and participants indicated which actions may have occurred and their helpfulness. Participants also reported delays in start of insulin therapy after the initial recommendation and any period of discontinuation of therapy.

In an exploratory factor analysis, researchers grouped health care professional actions into five factors: explained insulin benefits (i.e., highlighted the gain likely to accrue from insulin use; reported by 97% of cohort), dispelled insulin myths (i.e., addressed the patient's possible misgivings or misinformation; reported by 89% of cohort), demonstrated the injection process (i.e., reducing fears and discomfort about the injection procedure; reported by 94% of cohort), collaborative style (i.e., efforts to include the patient in the decision-making process; reported by 89% of cohort), and authoritarian style (i.e., a more demanding, paternalistic approach; reported by 54% of cohort). Results of the industry-sponsored study were published online on Jan. 17 by the Journal of Diabetes and its Complications.

Participants rated level of helpfulness on a scale of 1 (action was not helpful) to 4 (action helped a lot). Overall, demonstrating the injection process (mean helpfulness level, 3.07), explaining insulin benefits (mean helpfulness level, 2.97), and having a collaborative style (mean helpfulness level, 2.92) were associated with the highest levels of helpfulness, while dispelling insulin myths (mean helpfulness level, 2.77) and having an authoritarian style (mean helpfulness level, 2.63) yielded the lowest levels of helpfulness.

Patients who rated demonstration of the injection process as helpful were less likely to report delaying insulin therapy than those who rated it as less helpful (odds ratio [OR], 0.75; P=0.01). In addition, those who rated collaborative style and explaining insulin benefits as helpful were less likely to report interrupting insulin therapy than those who rated these factors as less helpful (OR, 0.55 [P<0.01] and OR, 0.51 [P=0.01], respectively). Conversely, ratings of helpfulness for an authoritarian style and dispelling insulin myths were not significantly associated with reported insulin initiation delays or periods of discontinuation.

The study authors noted limitations, such as the retrospective design and between-country differences in provided incentives and the number of participants. In addition, survey respondents were recruited from online panels of individuals who volunteer to participate in studies and may have been more involved in their type 2 diabetes care than others, they said.