Overcoming Barriers to the Initiation of Insulin Therapy

Abstract

N ew recommendations for the management of type 2 diabetes call for more rapid initiation of both oral medications and insulin therapy.1 Although most providers agree that insulin is an efficacious approach to the management of type 2 diabetes, many still consider insulin therapy as the last resort and indicate that their patients are hesitant to take insulin.2 In addition, the initiation of insulin therapy is difficult in the confines of a 10-minute office visit. The first step is to determine the patient's view of insulin therapy and correctly identify barriers from the patient's perspective. The discussion about the need for insulin therapy affects people differently. Some may feel angry or betrayed, others fear that insulin will add to the burden and stress of managing diabetes, and still others may feel overwhelmed or frightened.3 To determine a patient's concerns, ask questions such as: 1. What do you need to know to consider insulin therapy? 2. What problems do you think you will encounter? 3. What do you see as the biggest negative of insulin? The greatest benefit? 4. What would help you overcome your concerns? 5. Are you willing to try insulin? If not, what would cause you to consider insulin? The first response to such questions is very rarely a full accounting of the patients' true concerns. Continuing to ask questions, such as “Why do you think that is?” or “Can you tell me more about that?” will help both you and the patient better understand the existing barriers so that you can best support patients in the decision-making process. The decision to initiate insulin therapy ultimately belongs to the patient with type 2 diabetes. Common barriers among patients include beliefs that insulin is a personal failure, that insulin is not effective, that insulin causes complications or even death, or that …