Barriers to achieving glycemic targets: who omits insulin and why?
Open accessAbstract
Improved glycemic control in people with diabetes delays the onset and progression of severe microvascular complications of diabetes (1,2). Despite advances in pharmacotherapy and diabetes treatment devices and the emphasis placed on treatment adherence over the last decade, National Health and Nutrition Examination Survey (NHANES) data showed 45% of patients with diabetes did not achieve glycemic targets of <7% (3). Although some patients with diabetes may be undertreated (e.g., inappropriate treatment regimens, psychosocial issues that require adjustment in therapeutic targets), one reason for poor glycemic control is patients' difficulty in following treatment prescriptions and recommendations for diabetes self-care. The number of diabetes medications prescribed and the number of people using diabetes medications have increased exponentially as a result of increasing prevalence rates in type 2 diabetes. Insulin is an extremely effective glucose-lowering treatment that is a medical requirement for type 2 diabetes when the pancreas fails. Approximately 27% of all people with diabetes take insulin (4). Surprisingly little is known about factors related to adherence to medication prescriptions and, more specifically, intentional insulin omission and how underlying motivations for insulin omission differ by type of diabetes. A recent study in this issue of Diabetes Care by Peyrot et al. (5) brings this issue to the forefront. The purpose of this study was to explore the frequency of intentional insulin omission and the factors associated with this behavior in a sample of 502 U.S. adults self-identified as taking insulin by injection to treat either type 1 or type 2 diabetes. Fifty-seven percent of the respondents reported omitting insulin injections, with 20% omitting insulin injections regularly. Regression analyses identified older age, lower income and education, type 2 diabetes, poor diet adherence, more frequently prescribed injections, interference with daily activities, pain, and embarrassment as independent risk factors for intentional insulin omission. …
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For people with type 2 diabetes treated with insulin, intentional insulin omission is also frequently reported.
“For people with type 2 diabetes treated with insulin, intentional omission is also frequently reported (82).”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [82]
For people with type 2 diabetes treated with insulin, intentional omission is also frequently reported.
“For people with type 2 diabetes treated with insulin, intentional omission is also frequently reported (404).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [404]
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References 36 · Cited by 53
- Authors
- Weinger, K., & Beverly, E. A.
- Affiliations
- Joslin Diabetes Center (US)
- Corresponding author
- Weinger, Katie
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2010-02-01
- Volume
- 33
- Issue
- 2
- Pages
- 450-452
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC2809300
- OpenAlex
- W2156312316
- Cited by
- 53
- References
- 36
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 4 · 2018: 5 · 2017: 6 · 2016: 10 · 2015: 1 · 2014: 2 · 2013: 2
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (P30-DK36836, P30DK036836)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- insulin omission, glycemic control, type 1 diabetes, type 2 diabetes, medication adherence, diabetes self-care, barriers to treatment adherence, socioeconomic factors, dietary adherence
- MeSH terms
- Attitude to Health, Blood Glucose, Diabetes Mellitus, Diet, Diabetic, Educational Status, Humans, Hypoglycemic Agents, Income, Insulin, Nutrition Surveys, Reference Values, Treatment Refusal
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