Reluctance to begin insulin therapy leads many patients and doctors to delay insulin therapy until complications associated with poor glycaemic control are already evident. Many reasons for this have been identified, including:
- Self-blame, or a sense that having to start insulin therapy is a sign of failure to properly manage their diabetes
- Fears related to the process of injection
- Concerns about the potential complexity of insulin regimens
- Anxiety over potential hypoglycaemic episodes and weight gain
Physicians may also be reluctant to initiate insulin therapy due to the time required to teach patients about insulin, including the risk of hypoglycaemia, and how to administer it. They may also be concerned about their patients' willingness to inject insulin several times a day and to intensify blood glucose monitoring.
These concerns can be addressed through patient and physician education about the advances in insulin treatment made through the introduction of modern insulins and delivery devices and by the use of regimens based on modern insulins.
Recommendations for overcoming barriers to starting insulin
- Self-blame can be addressed by helping the patient to understand that diabetes is a progressive disease and that initiation of insulin therapy is expected as part of disease management. Patients should also understand the benefits of improved glycaemic control offered by insulin therapy in avoiding complications of diabetes
- Injection fears can be addressed through the use of shorter, finer needles with modern insulin pens - these have been shown to be associated with less pain and bruising. Needles are now available with a one-twist attachment that is preferred by patients for ease of use. Patients may wish to handle these devices for themselves during the consultation
- Patients who are concerned about injecting in public can be reassured by the flexibility, convenience and discreetness of modern insulin pens. Clinical studies have demonstrated that, in comparison to vial and syringe, patients find that insulin pens offer greater lifestyle flexibility, are faster to use, easier to read and more portable. Patients may also prefer regimens that require fewer injections
- Concerns about the complexity of insulin regimens can be addressed by the use of insulin pens. Regimens that require fewer injections also help to simplify insulin therapy. Prefilled insulin pens or durable pens are part of an integrated delivery system that addresses all the modern insulin needs of patients with diabetes
- Risk of hypoglycaemia is a concern among patients and doctors. Good compliance and accuracy of dosing are associated with good metabolic control and a lower risk of hypoglycaemia. Thus, insulin pens that combine dose accuracy with patient confidence and preference may reduce the risk of hypoglycaemic events. Physicians should adjust insulin doses in small increments. Prefilled and durable insulin pens are available in a basal analogue and a rapid acting analogue
Greater convenience, flexibility, treatment satisfaction, ease of use, perceived dosing accuracy, reduced pain and social stigma and faster administration time experienced with insulin pens compared to vials and syringes could influence a patient's willingness to initiate insulin therapy. Moreover, in comparisons of prefilled and durable insulin pens with conventional vials and syringes, a majority of patients not only preferred the pens, but would also recommend them to other patients.
Modern insulin pens can help encourage patients to start insulin therapy
Novo Nordisk has been at the forefront of the development of modern insulins and delivery devices that can help doctors and their patients to overcome reluctance to initiate insulin therapy.
Novo Nordisk offers a range of prefilled and durable pens that can help to simplify insulin regimens and have been proven to be more user-friendly than a vial and syringe. Their simplicity of use and discreet appearance make these pens easy to use in even the most public of places. Novo Nordisk's integrated insulin delivery system also comprises a choice of easy-to-attach needles, including short, fine-gauge needles, which have been shown to reduce injection pain compared to conventional needles. Patients concerned about pain can also be reassured by prefilled pens and durable pens that use a lower injection force to deliver insulin. Most importantly though, both prefilled pens and durable pens have been demonstrated to reliably and accurately deliver the required dose of insulin so that patients can trust their pen to help control their blood glucose levels.