September 26, 2017
2 min read

Reluctance to start insulin therapy common in adults with diabetes

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Alexander Turchin
Alexander Turchin

Three in 10 adults with diabetes initially decline insulin therapy, which may lead to progression of hyperglycemia and a delay in achieving glycemic control, according to findings published in Diabetic Medicine.

Alexander Turchin, MD, MS, director of quality in diabetes in the division of endocrinology, diabetes and hypertension at Brigham and Women’s Hospital, and colleagues developed an algorithm using a natural language processing platform to identify patients’ declining of insulin therapy from physician notes and to determine the prevalence of decline and its effect on insulin initiation. Notes of 1,501 primary care physicians from an electronic medical record system (2000-2014) were used for evaluation.

The algorithm was observed to have a sensitivity of 100%, positive predictive value of 95% and specificity of 99.9% for documentation of insulin therapy decline.

Through the records, 3,295 adults with diabetes without a history of insulin prescription were identified; 984 of them had declined insulin therapy.

Patients with diabetes were categorized into three groups based on insulin levels: 52 mmol/mol to 63 mmol/mol; 64 mmol/mol to 74 mmol/mol; and 75 mmol/mol or higher.

Patients with HbA1c of at least 75 mmol/mol were most likely to have declined insulin therapy (34.2%) vs. patients with HbA1c levels of 53 mmol/mol to 63 mmol/mol (15.1%) and 64 mmol/mol to 74 mmol/mol (25.4%; P < .0001 for the difference among the three groups).

Thirty-eight percent of patients who initially declined insulin began therapy after a mean of 790 days; mean HbA1c in this group rose from 71 mmol/mol to 76 mmol/mol until initiation of therapy.

“Decline of insulin therapy by patients is a major clinical phenomenon that may potentially have substantial impact on their blood glucose control and long-term clinical outcomes,” Turchin told Endocrine Today. “Decline of insulin therapy by patients is associated with significant delays in initiation of insulin in eligible patients, and may impede timely achievement of blood glucose control. We need to study the reasons for and outcomes of decline of insulin therapy by patients, so that we can learn how to be more effective in initiating insulin therapy.” – by Amber Cox

For more information:

Alexander Turchin, MD, MS, can be reached at

Disclosures: Turchin reports he is an advisory board member for Monarch Medical Technologies and Novo Nordisk. No other authors report relevant financial disclosures.