Overcoming patient barriers to insulin therapy

Insulin therapy is an important part of effective type 2 diabetes management, yet insulin therapy initiation is often delayed, sometimes for as long as 5 years.1-3 One important driver for this delay is clinical inertia, with resistance from the patients themselves playing a key role.4

Scroll down or click an icon below to explore ways to address clinical inertia and improve treatment outcomes for your patients. Plus, register today and get this FREE downloadable tool exclusively for members!

Peyrot, Mark et al. Addressing barriers to initiation of insulin in patients with type 2 diabetes.
Primary Care Diabetes 4, suppl. 1 (2010) S11–S18

01.

Assess

Before visit

Effectively communicating with your patients can begin with contacting them before a visit to learn how they feel about their diabetes and about insulin therapy.4

More than half (52%) of insulin-naïve patients in one study were worried about starting insulin therapy, and 48% believed that starting insulin meant they had failed to manage their diabetes.4

Only 1 in 5 patients believed that insulin would help them manage their diabetes better.4

Many patients have significant concerns about weight gain and hypoglycemia. 5

Every patient is different and has different attitudes toward their disease and its treatment.
Send your patients the diabetes distress test to learn about their unique concerns.

02.

Advise

Before or during visit

Addressing specific concerns is one way to change patient attitudes and behavior. Take time to discuss concerns in a personal, meaningful way.4

Click a patient barrier to discover a solution

If a patient feels that taking insulin means they have failed personally:

Explain to patients that adding insulin to therapy is a natural step in managing the progression of diabetes.4

If a patient thinks that insulin is not an effective treatment:

Assure them that when used properly, insulin is one of the best tools for glycemic control. It may also help them feel better and more energized.4

If a patient feels like they have lost control:

Advise the patient that an insulin regimen can help them take control of their diabetes.4

If a patient is anxious about injections:

Demonstrate that injection needles are small. Tell them that they are less painful than those used for blood glucose self-monitoring. Prefilled insulin pens can make injections simpler.4

If a patient fears hypoglycemia:

Assure them that severe hypoglycemia is rare. Long-acting, once-daily formulations have a lower risk of causing hypoglycemia.4

If a patient fears weight gain:

Explain that once-daily formulations and some modern insulins have been shown to produce less weight gain. Reiterate the role of exercise both in minimizing weight gain and improving glycemic control.4

03.

Agree

During visit

By collaborating and agreeing on specific goals and priorities, you can help set your patients up for success with their insulin treatment regimen.4

Points of discussion:

Target A1C levels

Reiterating what a safe A1C level is as well as the timeframe in which the patient can expect to achieve it can help set expectations about the efficacy of insulin treatment.

Physical activity goals

As always, small, achievable physical goals can help patients get on track to achieve larger ones.

Insulin injection habits

Work with the patient to agree on the best time to take their injections according to their schedule, giving them a clear path to adherence.

The social aspects of insulin

Patients on insulin therapy can be concerned about the opinion of others. Assure them that the therapy should not impact their ability to work, and help them form a plan to make sure that the people closest to them know everything they need to know.4

Eye exams for patients with diabetes

Patients should be reminded to be on the lookout for diabetic retinopathy, and that controlling blood sugar by staying adherent to treatment is one way to avoid that potential complication.6

04.

Assist

During or after visit

After youʼve identified your patients’ barriers to taking insulin, develop an action plan to help your patients achieve the goals youʼve set together and get their A1C under control.4

For other questions and concerns, direct patients to local diabetes educators and other helpful resources such as:

Diabetes Educator Website

A good resource to find local diabetes educators, as well as helpful tips and tools

Read more

The American Diabetes Association

Useful content for any patient, regardless of where they are in their diabetes journey

Read more

The CDC's national diabetes education program

In-depth education to help patients take charge of their diabetes

Read more
05.

Arrange

After visit

Following up with your patients after their visits can help you identify and address any hurdles they may encounter with their insulin therapy regimen.4

A simple phone call or email can help make sure your patients stay on track.

Every patient has unique challenges. Take our poll and let us know your patientsʼ barriers to beginning insulin therapy.

Take Poll
References

1. Nathan DM, Buse JB, Davidson MB, et al. Management of hyperglycemia in type 2 diabetes; a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. (B); 1963-1972

2. Turner RC, Cull CA, Frighi V, Holman RR; for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). JAMA. 1999;281(21):2005–2012.

3. Rubino A, McQuay LJ, Gough SC, Kvasz M, Tennis P. Delayed initiation of subcutaneous insulin therapy after failure of oral glucose-lowering agents in patients with type 2 diabetes: a population-based analysis in the UK. Diabet Med. 2007;24(12):1412–1418.

4. Peyrot M, Rubin RR, Khunti K. Addressing barriers to initiation of insulin in patients with type 2 diabetes. Prim Care Diabetes. 2010;4(suppl 1):S11–S18.

5. Brod M, Kongsø JH, Lessard S, Christensen TL. Psychological insulin resistance: patient beliefs and implications for diabetes management. Qual Life Res. 2009;18(1):23–32.

6. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet.1998;352(9131):837–853.

What are your patientsʼ biggest barriers to starting and staying on insulin?

Instructions:

Select a number from the dropdown menu below each image to rank your patientsʼ barriers to adherence from 1 (the most significant) to 5 (the least significant).

Emotional burden
Too busy
Skipped meals
Travel
Public-embarrassment
All values must be filled.
References

1. Nathan DM, Buse JB, Davidson MB, et al. Management of hyperglycemia in type 2 diabetes; a consennsus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. (B); 1963-1972

2. Turner RC, Cull CA, Frighi V, Holman RR; for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). JAMA. 1999;281(21):2005–2012.

3. Rubino A, McQuay LJ, Gough SC, Kvasz M, Tennis P. Delayed initiation of subcutaneous insulin therapy after failure of oral glucose-lowering agents in patients with type 2 diabetes: a population-based analysis in the UK. Diabet Med. 2007;24(12):1412–1418.

4. Peyrot M, Rubin RR, Khunti K. Addressing barriers to initiation of insulin in patients with type 2 diabetes. Prim Care Diabetes. 2010;4(suppl 1):S11–S18.

5. Brod M, Kongsø JH, Lessard S, Christensen TL. Psychological insulin resistance: patient beliefs and implications for diabetes management. Qual Life Res. 2009;18(1):23–32.

6. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–853

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