[acb-diabetics] why doctors do not presccribe insulin earlieerk

[Patricia LaFrance-Wolf]

This article originally posted 13 April, 2010 and appeared in  

Issue 517

 

Why Physicians Do Not Initiate Insulin Earlier

 

In a current study it was found that there are certain barriers for
physicians that prevent them prescribing insulin much earlier in the
treatment of diabetes....

 

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Reasons for failing to initiate prescribed insulin (primary nonadherence)
are poorly understood. So, this study set out to understand the barriers.

 

Researchers surveyed insulin-naïve patients with poorly controlled Type 2
diabetes, already treated with two or more oral agents who were recently
prescribed

insulin. They compared responses for respondents prescribed, but never
initiating, insulin (n = 69) with those dispensed insulin (n = 100). 

 

The results showed that the 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. 

 

>From the results it was concluded that among poorly controlled patients with
Type 2 diabetes newly prescribed insulin, the major predictors of insulin
nonadherence

included plans to improve health behaviors in lieu of starting insulin,
negative impact on social and work life, injection phobia, and concerns
about side

effects or hypoglycemia. 

 

Nonadherent patients often blamed themselves, believing prior poor
self-management caused the current need for insulin and erroneously
conceptualized insulin

as itself the cause of future complications. These patient-level findings
are consistent with previous studies of attitudes about insulin. Not
previously

reported is the finding that nonadherent patients frequently felt their
provider had not adequately explained the risks and benefits of insulin. 

 

The importance of provider communication is underscored by the association
between insulin initiation and health literacy. Primary nonadherence likely
also

reflects inadequate shared decision making or lack of self-management
training. Interventions for PIR need to address both provider- and
system-level factors.

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