Demonstrating the injection process, taking a collaborative approach to treatment and explaining benefits, are effective strategies for health care professionals trying to encourage correct insulin use in adults with type 2 diabetes, according to findings published in the Journal of Diabetes and its Complications.
William H. Polonsky
“Often people are so fearful or put off by the idea of injections that they can’t go any farther than that,” William H. Polonsky, PhD, CDE, the president of the Behavioral Diabetes Institute and an associate clinical professor at the University of California, San Diego, told Endocrine Today. “Once it has been demonstrated to them that we’re talking about a process that’s very simple, a need they’re not even going to feel, then we can talk about it. Then we can address some of the other issues that are important.”
Polonsky and colleagues sent an online survey to 594 adults with type 2 diabetes on insulin therapy (mean age, 53.3 years; 43% women; mean time since type 2 diabetes diagnosis, 8.2 years) from Brazil, Canada, Germany, Spain, the U.K., the U.S. and Japan between December 2016 and August 2017. Participants were asked to evaluate how resistant they were to insulin treatment, how often a given practice was conducted by their health care professional and the helpfulness of each practice. Helpfulness was rated on a four-point scale where a score of four equated to very helpful and a score of one was considered not helpful. Participants also provided information about the time it took to begin insulin treatment after recommendation and the persistence of treatment.
According to respondents, factors for insulin treatment adoption in order of most to least meaningful were that a health care professional demonstrated the injection process (mean score, 3.07), explained insulin benefits (mean score, 2.97), used a collaborative style (mean score, 2.92), dispelled insulin myths (mean score, 2.77) and used an authoritarian style (mean score, 2.63). The participants also reported that four of these practices were performed at least 89% of the time, whereas the authoritarian style was reported just 54% of the time.
Some participants indicated that they had previously used an injectable treatment. These participants considered demonstrating the injection process, explaining insulin benefits, as well as using a collaborative or authoritarian style as more helpful than participants who had never used an injection before (P < .05). Compared with participants with a BMI below 25 kg/m2, participants with a BMI of 30 kg/m2 or more found the demonstration of the injection process, explanation of insulin benefits and a collaborative style more helpful (P < .05).
The researchers noted that delaying insulin treatment was less likely for participants who rated the injection process demonstration as the most helpful (OR = 0.75; P = .01). Less insulin discontinuation was noted for participants who found a collaborative style (OR = 0.55; P < .01) and an explanation of insulin benefits (OR = 0.51; P = .01) the most helpful. An authoritarian style was more likely to lead to a delay in insulin treatment (OR = 3.06; P < .01) or a gap in insulin adherence of at least 7 days (OR = 2.58; P < .01).
“When you are introducing insulin to people with type 2 diabetes, it’s important not to just give them a prescription and get started, but especially if you perceive that they might be uncomfortable and reluctant to do so, take the time to show them what the process is,” Polonsky said. “Approach the idea of staring insulin in a more collaborative manner, when you’re not just authoritatively instructing people what they are going to do, but approaching your patients as empowered partners. Our data suggest also that you’re much more likely to be successful in helping patients to overcome their own reluctance and be willing to give insulin a try.” – by Phil Neuffer
Disclosures: Eli Lilly sponsored this study. Polonsky reports he has served as a consultant for AstraZeneca, Dexcom, Eli Lilly, Intarcia, Mannkind, Merck, Novo Nordisk and Sanofi. Please see the study for all other authors’ relevant financial disclosures.