Correlates of Insulin Injection Omission

  1. Mark Peyrot, PHD1,2,
  2. Richard R. Rubin, PHD, CDE2,3,
  3. Davida F. Kruger, MSN, APN-BC, BC-ADM4 and
  4. Luther B. Travis, MD, FAAP5
  1. 1Department of Sociology, Loyola University Maryland, Baltimore, Maryland;
  2. 2Department of Medicine, Johns Hopkins University, Baltimore, Maryland;
  3. 3Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland;
  4. 4Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Health Systems, Detroit, Michigan;
  5. 5Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas.
  1. Corresponding author: Mark Peyrot, mpeyrot{at}


OBJECTIVE The purpose of this study was to assess factors associated with patient frequency of intentionally skipping insulin injections.

RESEARCH DESIGN AND METHODS Data were obtained through an Internet survey of 502 U.S. adults self-identified as taking insulin by injection to treat type 1 or type 2 diabetes. Multiple regression analysis assessed independent associations of various demographic, disease, and injection-specific factors with insulin omission.

RESULTS Intentional insulin omission was reported by more than half of respondents; regular omission was reported by 20%. Significant independent risk factors for insulin omission were younger age, lower income and higher education, type 2 diabetes, not following a healthy diet, taking more daily injections, interference of injections with daily activities, and injection pain and embarrassment. Risk factors differed between type 1 and type 2 diabetic patients, with diet nonadherence more prominent in type 1 diabetes and age, education, income, pain, and embarrassment more prominent in type 2 diabetes.

CONCLUSIONS Whereas most patients did not report regular intentional omission of insulin injections, a substantial number did. Our findings suggest that it is important to identify patients who intentionally omit insulin and be aware of the potential risk factors identified here. For patients who report injection-related problems (interference with daily activities, injection pain, and embarrassment), providers should consider recommending strategies and tools for addressing these problems to increase adherence to prescribed insulin regimens. This could improve clinical outcomes.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

  • See accompanying editorial, p. 450.

    • Received July 22, 2009.
    • Accepted October 19, 2009.
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