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Cited by 655Medication Adherence and ComplianceDiabetes Management and EducationDiabetes Management and Research

Insulin adherence behaviours and barriers in the multinational global attitudes of patients and physicians in insulin therapy study

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Peyrot, M., Barnett, A. H., Meneghini, L. F., Schumm‐Draeger, P.‐M.·2012·Diabetic Medicine
DOI 10.1111/j.1464-5491.2012.03605.xPMC PMC3433794
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Abstract

AIMS: To examine patient and physician beliefs regarding insulin therapy and the degree to which patients adhere to their insulin regimens. METHODS: Internet survey of 1250 physicians (600 specialists, 650 primary care physicians) who treat patients with diabetes and telephone survey of 1530 insulin-treated patients (180 with Type 1 diabetes, 1350 with Type 2 diabetes) in China, France, Japan, Germany, Spain, Turkey, the UK or the USA. RESULTS: One third (33.2%) of patients reported insulin omission/non-adherence at least 1 day in the last month, with an average of 3.3 days. Three quarters (72.5%) of physicians report that their typical patient does not take their insulin as prescribed, with a mean of 4.3 days per month of basal insulin omission/non-adherence and 5.7 days per month of prandial insulin omission/non-adherence. Patients and providers indicated the same five most common reasons for insulin omission/non-adherence: too busy; travelling; skipped meals; stress/emotional problems; public embarrassment. Physicians reported low patient success at initiating insulin in a timely fashion and adjusting insulin doses. Most physicians report that many insulin-treated patients do not have adequate glucose control (87.6%) and that they would treat more aggressively if not for concern about hypoglycaemia (75.5%). Although a majority of patients (and physicians) regard insulin treatment as restrictive, more patients see insulin treatment as having positive than negative impacts on their lives. CONCLUSIONS: Glucose control is inadequate among insulin-treated patients, in part attributable to insulin omission/non-adherence and lack of dose adjustment. There is a need for insulin regimens that are less restrictive and burdensome with lower risk of hypoglycaemia.

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  • There is a clear need for intuitive, integrated systems to help MDI patients interpret CGM data into actionable management steps to reduce the burden of demanding self-care directives and support telemedicine.

    “As injection therapy is used by more than 80% of people with insulin-requiring diabetes, there is a clear need for intuitive, integrated systems to help multiple daily injection (MDI) patients interpret CGM data into actionable management steps to reduce the burden of demanding self-care directives and support telemedicine (3, 6, 10-13).”

    From Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis (2025) · cites this paper as [3]

    The Discussion’s Clinical implications section says patients have difficulty adjusting insulin doses to daily changes and recommends reducing the burden of restrictive regimens. It does not support the specific need for integrated systems to interpret CGM data, support telemedicine, or the sentence’s more-than-80% figure. (LLM, conf=0.88)

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  • For people with insulin-requiring diabetes, dosing instructions may be complex and confusing.

    “For people with insulin-requiring diabetes, dosing instructions may be complex and confusing (3-6).”

    From Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis (2025) · cites this paper as [3]

    The Discussion reports dissatisfaction with regimen simplicity, and the Clinical implications section says patients have difficulty adjusting insulin doses to daily changes. These passages support the possibility that dosing is complex, but they do not say that dosing instructions themselves are confusing. No page numbers are available in our copy. (LLM, conf=0.82)

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  • Injection therapy is used by more than 80% of people with insulin-requiring diabetes.

    “As injection therapy is used by more than 80% of people with insulin-requiring diabetes, there is a clear need for intuitive, integrated systems to help multiple daily injection (MDI) patients interpret CGM data into actionable management steps to reduce the burden of demanding self-care directives and support telemedicine (3, 6, 10-13).”

    From Observed Glycemic and Psychosocial Benefits in the Prospective Bigfoot Unity Real World Study: A 6-Month Analysis (2025) · cites this paper as [3]

    Table 1 (Participants and methods > Statistical analysis; page unavailable) reports that 98.5% of the 1,530 surveyed insulin users used a pen, syringe, or both, supporting the claim for this sample. The Study design section says participants were recruited from research-consumer panels; the paper does not establish that more than 80% of all people with insulin-requiring diabetes use injection therapy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Similar to all insulin analogues, the risk of hypoglycaemia is a major safety concern, and is considered a key obstacle in regulating blood glucose levels by both patients and physicians.

    “Similar to all insulin analogues, the risk of hypoglycaemia is a major safety concern, and is considered a key obstacle in regulating blood glucose levels by both patients and physicians [10, 57].”

    From A Review of the Pharmacological Properties of Insulin Degludec and Their Clinical Relevance (2014) · cites this paper as [10]

    The Results (Survey responses; page unavailable) report that physicians see hypoglycaemia as limiting treatment aggressiveness and making glucose control and safety difficult to balance. The Introduction mentions patient concerns about insulin safety, but does not establish that patients consider hypoglycaemia a key obstacle to glucose control. The paper discusses insulin therapy generally, not all insulin analogues. (LLM, conf=0.86)

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Authors
Peyrot, M., Barnett, A. H., Meneghini, L. F., & Schumm‐Draeger, P. ‐.
Affiliations
  • Johns Hopkins University (US)
  • Heart of England NHS Foundation Trust (GB)
  • University of Miami (US)
  • München Klinik Bogenhausen (DE)
Corresponding author
Peyrot, M.
ORCID
Venue
Diabetic Medicine
Publisher
Wiley
Published
2012-04-16
Volume
29
Issue
5
Pages
682-689
ISSN
  • 0742-3071 (ISSN-L)
  • 1464-5491
DOI
10.1111/j.1464-5491.2012.03605.x
PMC
PMC3433794
OpenAlex
W1613501644
Cited by
655
References
22
Citations by year
2026: 29 · 2025: 41 · 2024: 61 · 2023: 43 · 2022: 42 · 2021: 43 · 2020: 53 · 2019: 49 · 2018: 52 · 2017: 48 · 2016: 52 · 2015: 50 · 2014: 46 · 2013: 35 · 2012: 8
FWCI
38.62
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Diabetic Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
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 Management and Research
Keywords
insulin therapy, insulin adherence, insulin omission, barriers to adherence, patient beliefs, physician beliefs, type 1 diabetes, type 2 diabetes, glycemic control, hypoglycemia, basal insulin, prandial insulin, insulin dose adjustment
MeSH terms
Assessment of Medication Adherence, Blood Glucose, China, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, France, Germany, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Japan, Male, Middle Aged, Spain, Turkey, United States, Health Behavior, Drug Monitoring, Medication Adherence

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