Resistance to insulin therapy among patients and providers: Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study

Mark Peyrot, Richard R. Rubin, Torsten Lauritzen, Soren E. Skovlund, Frank J. Snoek, David R. Matthews, Rüdiger Landgraf, Line Kleinebreil

    Research output: Contribution to journalArticle

    Abstract

    OBJECTIVE - To examine the correlates of patient and provider attitudes toward insulin therapy. RESEARCH DESIGN AND METHODS - Data are from surveys of patients with type 2 diabetes not taking insulin (n = 2,061) and diabetes care providers (nurses = 1,109; physicians = 2,681) in 13 countries in Asia, Australia, Europe, and North America. Multiple regression analysis is used to identify correlates of attitudes toward insulin therapy among patients, physicians, and nurses. RESULTS - Patient and provider attitudes differ significantly across countries, controlling for individual characteristics. Patients rate the clinical efficacy of insulin as low and would blame themselves if they had to start insulin therapy. Self-blame is significantly lower among those who have better diet and exercise adherence and less diabetes-related distress. Patients who are not managing their diabetes well (poor perceived control, more complications, and diabetes-related distress) are significantly more likely to see insulin therapy as potentially beneficial. Most nurses and general practitioners (50-55%) delay insulin therapy until absolutely necessary, but specialists and opinion leaders are less likely to do so. Delay of insulin therapy is significantly less likely when physicians and nurses see their patients as more adherent to medication or appointment regimens, view insulin as more efficacious, and when they are less likely to delay oral diabetes medications. CONCLUSIONS - Patient and provider resistance to insulin therapy is substantial, and for providers it is part of a larger pattern of reluctance to prescribe blood glucose-lowering medication. Interventions to facilitate timely initiation of insulin therapy will need to address factors associated with this resistance.

    Original languageEnglish (US)
    Pages (from-to)2673-2679
    Number of pages7
    JournalDiabetes Care
    Volume28
    Issue number11
    DOIs
    StatePublished - 2005

    Fingerprint

    Insulin Resistance
    Insulin
    Therapeutics
    Nurses
    Physicians
    Nurse Practitioners
    Diabetes Complications
    North America
    General Practitioners
    Type 2 Diabetes Mellitus
    Blood Glucose
    Appointments and Schedules
    Research Design
    Regression Analysis
    Exercise
    Diet

    ASJC Scopus subject areas

    • Internal Medicine
    • Endocrinology, Diabetes and Metabolism

    Cite this

    Peyrot, M., Rubin, R. R., Lauritzen, T., Skovlund, S. E., Snoek, F. J., Matthews, D. R., ... Kleinebreil, L. (2005). Resistance to insulin therapy among patients and providers: Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care, 28(11), 2673-2679. https://doi.org/10.2337/diacare.28.11.2673

    Resistance to insulin therapy among patients and providers : Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. / Peyrot, Mark; Rubin, Richard R.; Lauritzen, Torsten; Skovlund, Soren E.; Snoek, Frank J.; Matthews, David R.; Landgraf, Rüdiger; Kleinebreil, Line.

    In: Diabetes Care, Vol. 28, No. 11, 2005, p. 2673-2679.

    Research output: Contribution to journalArticle

    Peyrot, M, Rubin, RR, Lauritzen, T, Skovlund, SE, Snoek, FJ, Matthews, DR, Landgraf, R & Kleinebreil, L 2005, 'Resistance to insulin therapy among patients and providers: Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study', Diabetes Care, vol. 28, no. 11, pp. 2673-2679. https://doi.org/10.2337/diacare.28.11.2673
    Peyrot, Mark ; Rubin, Richard R. ; Lauritzen, Torsten ; Skovlund, Soren E. ; Snoek, Frank J. ; Matthews, David R. ; Landgraf, Rüdiger ; Kleinebreil, Line. / Resistance to insulin therapy among patients and providers : Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. In: Diabetes Care. 2005 ; Vol. 28, No. 11. pp. 2673-2679.
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