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New data reveal why physicians and people with type 2 diabetes uncontrolled on basal insulin are reluctant to intensify insulin therapy
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Results from the Perceptions of Control (POC) study showed that people with type 2 diabetes uncontrolled on basal insulin were reluctant to intensify insulin therapy due to concerns such as medication side effects, perceptions of getting sicker and not wanting to add more injections. Physicians' concerns around insulin intensification included a lack of patient agreement to intensify insulin therapy, hypoglycaemia and patients' cognitive status. Findings from the Perceptions of Control study which evaluated the perceptions of diabetes control amongst patients and physicians were presented today at the World Diabetes Congress of the International Diabetes Federation (IDF).
"A better understanding of how patients and physicians make decisions around insulin intensification could significantly improve communication during consultations and help people with type 2 diabetes, uncontrolled on basal insulin, to intensify treatment when needed," said Meryl Brod, PhD, lead investigator of the POC study. "Addressing patient concerns with additional information and treatment options may lead to an increased number of patients agreeing to change their treatment to get into better control."
The POC study results showed that people with type 2 diabetes uncontrolled on basal insulin were apprehensive to intensify therapy and initiate basal-bolus insulin despite their physician's recommendation due to factors such as fear of weight gain caused by the medication (45%), feeling they were getting sicker (44%), fear of hypoglycaemia (low blood sugar) (41%) and not wanting to add more injections (41%). In total, over half (57%) were only somewhat or not at all willing (39% somewhat / a little willing, 18% not at all willing) to add one additional daily injection of bolus insulin to help control their type 2 diabetes and 37% were concerned that the regimen would be too complicated.
Physician study participants reported that the primary reason they were reluctant to intensify insulin therapy for people with type 2 diabetes uncontrolled on basal insulin was due to thinking their patients would not agree (62%). Physicians were also reluctant to intensify therapy due to concerns around hypoglycaemia (46%), especially if it was particularly dangerous in a patient's workplace (54%). Physicians were also concerned about recommending intensification if a patient had a mental illness or altered mental status (48%), poor cognitive skills (46%) and concerns of patient compliance (41%).
About the Perceptions of Control (POC) Study
The POC study was based on information collected from a web survey of 300 physicians and 1,012 adults with type 2 diabetes uncontrolled on basal insulin (physician-confirmed HbA1c> 8% (64 mmol/mol)) from the UK (n=100 physicians and 620 patients), Sweden (n=100 physicians and 240 patients) and Switzerland (n=100 physicians and 152 patients). Information was also collected from a control group of 295 adults with type 2 diabetes controlled on basal insulin (physician-confirmed HbA1c <7.5% (59 mmol/mol) from the UK. In total, data were collected from 1,607 patients and physicians for analysis.- The purpose of the study was to explore how physicians and people with type 2 diabetes define control, identify obstacles to achieving control,, perceive the impact of uncontrolled type 2 diabetes on daily life, and reluctance to intensify insulin therapy.
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1. Brod M, Pfeiffer KM, Barnett AH, et al. Patient/physicians inertia in insulin intensification for patients with uncontrolled type 2 diabetes using basal insulin. Poster presentation (1081-P) at the International Diabetes Federation (IDF) World Diabetes Congress, 1 December 2015. 2. Brod M, Pfeiffer KM, Barnett AH, et al. Perceptions of control among type 2 diabetes patients treated with basal insulin. Poster presentation (0742-P) at the International Diabetes Federation (IDF) World Diabetes Congress, 1 December 2015. 3. Brod M, Pfeiffer KM, Barnett AH, et al. Perceptions of diabetes control among physicians and patients with uncontrolled type 2 diabetes using basal insulin. Poster presentation (0741-P) at the International Diabetes Federation (IDF) World Diabetes Congress, 1 December 2015.