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Diabetes Care 28:2673-2679, 2005
© 2005 by the American Diabetes Association, Inc.

Epidemiology/Health Services/Psychosocial Research
Original Article

Resistance to Insulin Therapy Among Patients and Providers

Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study

Mark Peyrot, PHD1,2, Richard R. Rubin, PHD2, Torsten Lauritzen, MD3, Soren E. Skovlund, MSC4, Frank J. Snoek, PHD5, David R. Matthews, MD6, Rüdiger Landgraf, MD7, Line Kleinebreil8 on behalf of the International DAWN Advisory Panel*

1 Department of Sociology, Loyola College, Baltimore, Maryland
2 Department of Medicine, Johns Hopkins University, Baltimore, Maryland
3 Department of Medicine, Aarhus University, Aarhus, Denmark
4 Stakeholder Relations, Novo Nordisk, Bagsværd, Denmark
5 Department of Medical Psychology, Vrije University, Amsterdam, the Netherlands
6 Center for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, U.K
7 Department of Medicine, University of Munich, Munich, Germany
8 Department of Medicine, Jean Verdier Hospital, Bondy, France

Address correspondence and reprint requests to Mark Peyrot, PhD, Professor, Department of Sociology, Loyola College, 4501 North Charles St., Baltimore, MD 21210-2699. E-mail: mpeyrot{at}loyola.edu

OBJECTIVE—To examine the correlates of patient and provider attitudes toward insulin therapy.

RESEARCH DESIGN AND METHODS—Data are from surveys of patients with type 2 diabetes not taking insulin (n = 2,061) and diabetes care providers (nurses = 1,109; physicians = 2,681) in 13 countries in Asia, Australia, Europe, and North America. Multiple regression analysis is used to identify correlates of attitudes toward insulin therapy among patients, physicians, and nurses.

RESULTS—Patient and provider attitudes differ significantly across countries, controlling for individual characteristics. Patients rate the clinical efficacy of insulin as low and would blame themselves if they had to start insulin therapy. Self-blame is significantly lower among those who have better diet and exercise adherence and less diabetes-related distress. Patients who are not managing their diabetes well (poor perceived control, more complications, and diabetes-related distress) are significantly more likely to see insulin therapy as potentially beneficial. Most nurses and general practitioners (50–55%) delay insulin therapy until absolutely necessary, but specialists and opinion leaders are less likely to do so. Delay of insulin therapy is significantly less likely when physicians and nurses see their patients as more adherent to medication or appointment regimens, view insulin as more efficacious, and when they are less likely to delay oral diabetes medications.

CONCLUSIONS—Patient and provider resistance to insulin therapy is substantial, and for providers it is part of a larger pattern of reluctance to prescribe blood glucose–lowering medication. Interventions to facilitate timely initiation of insulin therapy will need to address factors associated with this resistance.

Abbreviations: DAWN, Diabetes Attitudes, Wishes, and Needs • SMBG, self-monitoring of blood glucose


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Find additional patient-related information at:

Attitudes Toward Insulin Therapy


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