Resistance to Insulin Therapy Among Patients and Providers: Results of the Cross-National Diabetes Attitudes, Wishes, and Needs (DAWN) Study
Response to Peyrot et al.
- George Phillipov, PHD and
- Patrick J. Phillips, FRCAP
- Address correspondence to Dr. G. Phillipov, Department of Endocrinology, The Queen Elizabeth Hospital, Woodville, South Australia 5011. E-mail: george.phillipov{at}nwahs.sa.gov.au
The recent article by Peyrot et al. (1) concerning the attitudes of both patients and providers with respect to insulin therapy raises some potentially important issues about barriers to an important treatment in diabetes. However, their statement that “U.S. physicians were significantly more disposed to delay insulin therapy than physicians in all other countries … ” (1) appears to contradict differences in cited prescribing patterns between type 2 diabetic patients in America, Australia, and Europe. For example, results from the National Health and Nutrition Examination Survey 1999–2000 cohort (2,3) and a large western U.S. study (4) are consistent in finding that ∼34% of type 2 diabetic patients on medication are using insulin. However, a more recent study (5) in the Canadian primary care setting reported only a 14% use of insulin, while two independent Australian studies (6,7) and our own results show an insulin prevalence of 16–18%. Studies in Denmark (8) and France (9) establish an insulin prescription rate of 24 and 17%, respectively. It therefore appears that physicians in U.S. are more likely to initiate insulin therapy for type 2 diabetic patients than their colleagues in other Western countries. The discrepancy between physicians’ attitudes, as reported by Peyrot et al. (1), and actual practice may represent a lack of generalizability of their findings or that the such “attitudes” are not the principal determinants of prescribing behavior.
Footnotes
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P.J.P. has been on an advisory board for and has received honoraria from Novo Nordisk and Aventis.
- DIABETES CARE
