Insulin non-persistence among people with type 2 diabetes: how to get your patients to stay on insulin therapy
Abstract
Continuing use of medication is key to effective treatment and positive health outcomes, particularly in chronic conditions such as diabetes. However, in primary care, non-persistence (i.e. discontinuing or interrupting treatment) with insulin therapy is a common problem among patients with type 2 diabetes. To help primary care physicians manage patients who are non-persistent or likely not to be persistent, this review aimed to provide an overview of modifiable and non-modifiable factors associated with insulin non-persistence as well as practical strategies to address them. Data were extracted from published studies evaluating factors associated with non-persistence among patients with type 2 diabetes. A targeted literature review was performed using PubMed to identify recent studies (2000-2016) reporting measures of non-persistence with insulin therapy. Practical strategies to identify and prevent non-persistence were based on the authors' direct experience in primary care. Non-modifiable factors associated with non-persistence included gender, age, prior treatments, and cost of therapy. Before/at insulin initiation, modifiable factors included patients' perception of diabetes, preference for oral medication, and concerns/expectations about treatment complexity, inconvenience, or side effects. After initiation, modifiable factors included syringe use, difficulties during the first week of therapy, side effects, and insufficient glycemic control. Open-ended and patient-centered questions and a blame-free environment can help physicians identify, prevent, and reduce non-persistence behaviors. Possible questions to start a conversation with patients are provided. Effective physician-patient communication is essential to the management of diabetes. Primary care physicians should be familiar with the most common reasons for insulin non-persistence.
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A negative attitude towards medication is also a problem in the treatment of chronic physical diseases such as diabetes and high blood pressure.
“A negative attitude towards medication is not only a psychiatric phenomenon but also a problem in the treatment of chronic physical diseases such as diabetes and high blood pressure [35, 36].”
From Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors (2021) · cites this paper as [36]
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- Authors
- Garnero, T. L., Davis, N. J., Perez-Nieves, M., Hadjiyianni, I., Cao, D., Ivanova, J. I., & Peyrot, M.
- Affiliations
- University of California, San Francisco (US)
- New York City Health and Hospitals Corporation (US)
- Eli Lilly and Company, Indianapolis, IN, USA
- Eli Lilly (United States) (US)
- Analysis Group (United States) (US)
- Loyola University Maryland (US)
- Venue
- Postgraduate Medicine
- Publisher
- Informa UK Limited
- Published
- 2018-04-06
- Volume
- 130
- Issue
- 4
- Pages
- 394-401
- ISSN
- 0032-5481 (ISSN-L)
- 1941-9260
- OpenAlex
- W2793565960
- Cited by
- 14
- References
- 35
- Citations by year
- 2023: 2 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 3
- FWCI
- 0.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Postgraduate Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, insulin therapy, medication adherence, primary care, patient-centered communication, physician-patient communication, treatment side effects, glycemic control, treatment costs, patient expectations
- MeSH terms
- Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Insulin, Motivation, Primary Health Care, Medication Adherence
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