Abstract

Objective- Reasons for failing to initiate prescribed insulin (primary non-adherence) are poorly understood. We investigated barriers to insulin initiation following a new prescription.

Research design and methods - We surveyed insulin-naïve patients with poorly controlled type 2 diabetes, already treated with ≥2 oral agents who were recently prescribed insulin. We compared responses for respondents prescribed, but never initiating, insulin (n=69) to those dispensed insulin (n=100).

Results - Subjects failing to initiate prescribed insulin commonly reported misconceptions regarding insulin risk (35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes or early death); plans to instead work harder on behavioral goals; sense of personal failure; low self-efficacy, injection phobia; hypoglycemia concerns; negative impact on social life and job; inadequate health literacy; healthcare provider inadequately explaining risks/benefits; and limited insulin self-management training.

Conclusions - Primary adherence for insulin may be improved through better provider communication regarding risks, shared decision making, and insulin self-management training.