Insulin Therapy Initially Declined and Delayed by an Average of Two Years 

Alexander Turchin

Although delaying insulin therapy leads to worsening of diabetes, new research by Brigham and Women’s Hospital (BWH) has found that 30 percent of patients with type 2 diabetes don’t begin insulin, a medication used to lower the body’s blood sugar levels, when it’s initially recommended, with the average start time being two years later. These findings were published today in the journal, Diabetic Medicine.

Alexander Turchin, MD, MS, Director of Quality in Diabetes in the Division of Endocrinology, Diabetes and Hypertension at BWH, who led the study, was inspired by his own practice as an endocrinologist treating patients with diabetes.

“Unfortunately, this isn’t uncommon, patients being reluctant to start insulin therapy when it’s recommended,” says Dr. Turchin. “Many clinicians have encountered this phenomenon, but until our study it was not known just how prevalent delays in insulin initiation are. As physicians, we need to make sure that these patients are making fully informed decisions and that we understand their perspective to ensure they are treated effectively.”

To find this information, investigators designed a computer program to analyze electronic physician notes of BWH patients from 2000 to 2014 to identify patients with type 2 diabetes who initially declined insulin therapy. Of the 3,295 patients included in the analysis, nearly one third declined a physician’s advice to begin insulin at the time the recommendation was made. People who initially declined, but ultimately accepted the recommendation to start insulin, on average started the insulin therapy more than two years later, during which time their blood glucose levels had increased further.

Diabetes is increasingly common in the United States, with over 30 million people affected. The high prevalence of decline of insulin therapy by patients that the study found suggests, per the researcher’s estimations, that it could mean over 1 million people in the U.S. find themselves in this situation. The team notes further investigation is needed to determine the reasons, risk factors, and long-term outcomes of these patients’ important clinical decision.

This research was supported by Sanofi.

Paper cited: Turchin et al. “Decline of insulin therapy and delays in insulin initiation in people with uncontrolled diabetes mellitus”. Diabetic Medicine DOI: 10.1111/dme.13454


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