Many Patients with Diabetes Delay Insulin Treatment

With nearly any condition, starting treatment as early as possible is linked to optimal patient outcomes. As many as 3 in 10 patients with type 2 diabetes who require insulin therapy do not start treatment when their providers advise them to, according to a new study published by Diabetic Medicine.

These patients were found to delay insulin therapy for an average of 2 years, which may threaten overall health and increase the risk of diabetes-related complications.

“This matters to patients because insulin therapy is typically offered to patients with high blood sugar levels,” said senior study author Alexander Turchin, MD, told Reuters by email. “If the patient does not start insulin therapy and does not initiate any other changes to bring their blood sugar levels down, their blood sugar can stay high for years, leading to diabetes complications such as blindness, kidney failure and heart attacks.”

Medication and lifestyle changes are crucial for managing diabetes symptoms and preventing adverse health events, including heart disease and stroke.

Previous studies show that many patients with diabetes do not start insulin when recommended; however, it was unclear whether this was the result of physicians not prescribing insulin or patients not adhering to the drug.

Included in the new study were data from electronic health records for 3295 patients with diabetes treated at Brigham and Women’s Hospital between 2000 and 2014.

The authors found that nearly one-third of patients did not start therapy, despite their physician’s recommendations, according to the study.

Patients who did not start treatment right away but eventually began insulin therapy, waited an average of 2 years. During this time, the authors found that blood sugar levels escalated.

The authors report that the study findings are limited since it was not a controlled experiment and some providers could have failed to note that patients declined treatment. Additionally, the authors hypothesize that some patients may be afraid of needles or have misconceptions about insulin, which could affect time to treatment.

Additional studies are needed to determine how widespread the trend of delaying therapy is and the underlying causes of the delay, as these factors may impact the overall health of patients.

These findings may also help physicians revise their strategy to get patients on treatment by stressing the need to immediately begin insulin because getting patients on therapy early is crucial for optimal outcomes.

“Insulin therapy decline is common, potentially leading to progression of hyperglycaemia [sic] and a delay in achievement of glycaemic [sic] control,” the authors concluded. “Further investigation is needed to determine the reasons, risk factors and long-term outcomes of this important clinical phenomenon.”