Resistance to Insulin Therapy Among Patients and Providers
Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study
- Mark Peyrot, PHD12,
- Richard R. Rubin, PHD2,
- Torsten Lauritzen, MD3,
- Soren E. Skovlund, MSC4,
- Frank J. Snoek, PHD5,
- David R. Matthews, MD6,
- Rüdiger Landgraf, MD7,
- Line Kleinebreil8 and
- on behalf of the International DAWN Advisory Panel*
- 1Department of Sociology, Loyola College, Baltimore, Maryland
- 2Department of Medicine, Johns Hopkins University, Baltimore, Maryland
- 3Department of Medicine, Aarhus University, Aarhus, Denmark
- 4Stakeholder Relations, Novo Nordisk, Bagsværd, Denmark
- 5Department of Medical Psychology, Vrije University, Amsterdam, the Netherlands
- 6Center for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, U.K
- 7Department of Medicine, University of Munich, Munich, Germany
- 8Department 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
Abstract
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.
Footnotes
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↵* Members of the DAWN Advisory Panel can be found in the appendix.
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M.P. has received honoraria/consulting fees from Novo Nordisk and MannKind Biopharmaceuticals and has received grant research support from Novo Nordisk. R.R.R. has been on an advisory board for Amylin, MannKind Biopharmaceuticals, Novo Nordisk, Novo Nordisk DK, and Takeda; has received honoraria from Novo Nordisk, Eli Lilly, and Takeda; has received consulting fees from Amylin, MannKind Biopharmaceuticals, Novo Nordisk, Novo Nordisk DK, Takeda, and Medtronic MiniMed; and has received grant/research support from MannKind Biopharmaceuticals, Novo Nordisk, Novo Nordisk DK, and Medtronic MiniMed. T.L. has been on an advisory panel for Novo Nordisk; has received honoraria/consulting fees from Novo Nordisk and AstraZeneca; and has received grant/research support from Novo Nordisk, AstraZeneca, Pfizer, Servier, and GlaxoSmithKline. F.J.S. has received honoraria/consulting fees from Novo Nordisk. R.L. has been on an advisory panel for Novo Nordisk Pharma Germany, Lilly Deutschlund, GlaxoSmithKline, and Novartis and has received honoraria/consulting fees from Lilly Deutschlund, Merck, Novo Nordisk, Lilly, Sanofi-Aventis, and GlaxoSmithKline.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted August 2, 2005.
- Received April 3, 2005.
- DIABETES CARE
