Barriers to Achieving Glycemic Targets: Who Omits Insulin and Why?

  1. Katie Weinger, EDD and
  2. Elizabeth A. Beverly, PHD
  1. From the Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, and the Section on Behavioral and Mental Health Research, Joslin Diabetes Center, One Joslin Place, Boston, Massachusetts.
  1. Corresponding author: Katie Weinger, katie.weinger{at}

Improved glycemic control in people with diabetes delays the onset and progression of severe microvascular complications of diabetes (1,2). Despite advances in pharmacotherapy and diabetes treatment devices and the emphasis placed on treatment adherence over the last decade, National Health and Nutrition Examination Survey (NHANES) data showed 45% of patients with diabetes did not achieve glycemic targets of <7% (3). Although some patients with diabetes may be undertreated (e.g., inappropriate treatment regimens, psychosocial issues that require adjustment in therapeutic targets), one reason for poor glycemic control is patients' difficulty in following treatment prescriptions and recommendations for diabetes self-care.

The number of diabetes medications prescribed and the number of people using diabetes medications have increased exponentially as a result of increasing prevalence rates in type 2 diabetes. Insulin is an extremely effective glucose-lowering treatment that is a medical requirement for type 2 diabetes when the pancreas fails. Approximately 27% of all people with diabetes take insulin (4). Surprisingly little is known about factors related to adherence to medication prescriptions and, more specifically, intentional insulin omission and how underlying motivations for insulin omission differ by type of diabetes.

A recent study in this issue of Diabetes Care by Peyrot et al. (5) brings this issue to the forefront. The purpose of this study was to explore the frequency of intentional insulin omission and the factors associated with this behavior in a sample of 502 U.S. adults self-identified as taking insulin by injection to treat either type 1 or type 2 diabetes. Fifty-seven percent of the respondents reported omitting insulin injections, with 20% omitting insulin injections regularly. Regression analyses identified older age, lower income and education, type 2 diabetes, poor diet adherence, more frequently prescribed injections, interference with daily activities, pain, and embarrassment as independent risk factors for intentional insulin omission. …

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