Barriers to insulin initiation: The translating research into action for diabetes insulin starts project

Andrew J. Karter, Usha Subramanian, Chandan Saha, Jesse C. Crosson, Melissa M. Parker, Bix E. Swain, Howard H. Moffet, David G. Marrero

Research output: Contribution to journalArticlepeer-review

205 Scopus citations


OBJECTIVE- Reasons for failing to initiate prescribed insulin (primary nonadherence) are poorly understood. We investigated barriers to insulin initiation following a new prescription. RESEARCH DESIGN AND METHODS- We surveyed insulin-naïve patients with poorly controlled type 2 diabetes, already treated with two or more oral agents who were recently prescribed insulin. We compared responses for respondents prescribed, but never initiating, insulin (n = 69) with those dispensed insulin (n = 100). RESULTS- Subjects failing to initiate prescribed insulin commonly reported misconceptions regarding insulin risk (35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death), plans to instead work harder on behavioral goals, sense of personal failure, low self-efficacy, injection phobia, hypoglycemia concerns, negative impact on social life and job, inadequate health literacy, health care provider inadequately explaining risks/benefits, and limited insulin self-management training. CONCLUSIONS- Primary adherence for insulin may be improved through better provider communication regarding risks, shared decision making, and insulin self-management training.

Original languageEnglish (US)
Pages (from-to)733-735
Number of pages3
JournalDiabetes care
Issue number4
StatePublished - Apr 2010
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing


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