30 million reasons

Initiating insulin is a big step for people living with type 2 diabetes.

In fact, up to 50% of patients diagnosed with type 2 diabetes say ‘no’ to insulin^1* for more than 2 years on average² after their healthcare professional (HCP) has recommended it as part of their treatment.

Different people have different reasons for delaying insulin initiation – including concerns over daily injections, anxiety, misconceptions or stigma.^1–9

But actually there are 30 million reasons for them to say ‘yes’. Because, worldwide, there are 30 million patients^10† who’ve overcome any worries they may have had, to get started on insulin.

Listen to some of their stories to hear different perspectives on how people can overcome their personal barriers to insulin initiation.

“I felt very confused.

I was a nurse and I was used to injecting other people. But the first time I had to inject myself, I was very afraid of it. Maybe because I was a nurse, the doctor thought I knew a lot of things. But when you have diabetes, you are not a nurse. You want to hear all the information, like a patient.

Everything the doctor explains can help a patient make a good decision.”  

Do you know a patient like Franca?

Many patients might relate to Franca’s story. They may be confused about why they must start on insulin or are afraid of injections. For patients like Franca, providing accessible explanations and reassurance can help them overcome their reluctance to insulin initiation.

“I hesitated for three months after my doctor suggested I start on insulin.

At the beginning, I didn’t want insulin treatment. I was afraid of needles. I was afraid the injections would be painful, and I was worried about people seeing me injecting in public. Now I’ve been injecting insulin for four years. I can take insulin at home every morning. So, it’s convenient, and I know there’s no need to be afraid.

The advice a doctor should give is that you don’t have to worry about injecting in public or people seeing you do it.”

The fear of needles, injection pain and judgement Yan experienced are not unique. By having an open conversation with your patients about their concerns, you may find they begin to feel more comfortable and confident about injecting insulin.

“For me, this was an emotional journey ...

... I didn't want to start on insulin. That’s why to doctors who are going to suggest their patients go on insulin, I’d say try to see the whole person. Try not to be too technical. Try to cover the emotional side as well. If you have a patient in front of you that might see it as a defeat — try to cover that.

I needed some words explaining that it would change my life … that I would get a better life."  

Do you know a patient like Eva?

Many patients like Eva may feel like their type 2 diabetes has ‘defeated’ them when their HCP first suggests insulin. These patients may feel empowered by having their concerns validated – and reassured to hear that initiating insulin is not a failure on their part.

“When my doctor recommended I use insulin, I felt great sadness that the illness had progressed a lot.

I hid my illness for years. Partly to not worry others and, partly, because I felt a bit of shame. My doctor always advised me on what I need to take for my type 2 diabetes, but I ignored him on a lot of things because I did not fully accept the illness … But I finally said ‘yes’ when I received all of the information and stories from other patients about the better quality of life it can offer.

My advice for doctors seeing patients like me is to boost their confidence and share patient stories.”

Patients like José Luis may be reluctant to start insulin therapy due to feeling ashamed of their diagnosis.³ Help them to feel more confident about living with their condition by understanding their emotional needs and sharing effective education to address them. This may even empower them to initiate insulin.^3,11

Gain insights, ideas and inspiration to help your patients living with type 2 diabetes take the next step to insulin initiation when the time is right with our library of insulin initiation masterclasses.

Watch Dr André Vianna, endocrinologist and diabetes specialist, discuss why patients delay insulin initiation, the impact this has on their outcomes and how to overcome common barriers in ‘Insulin inertia & its impact’.

Hear how empathy, reassurance and authenticity can drive good conversations about insulin initiation for type 2 diabetes with Martin Richards, communication expert, in ‘Initiation inspiration'.

See ‘Insulin initiation in action’, with Dr Peter Lin, family physician and Director of Primary Care Initiatives at the Canadian Heart Research Centre, presenting ways to identify and address a patient’s knowledge gaps during conversations to prepare them for insulin initiation.

We’ll be adding more patient stories over the coming months. So it’s going to be worth revisiting to see what’s new.

^*After failure of non-insulin glucose-lowering medications.¹
^†In a microsimulation of type 2 diabetes burden from 2018 to 2030 across 221 countries, it was estimated that the number of people with type 2 diabetes globally utilising insulin in 2018 was 30,229,435.¹⁰

Rubino A, et al. Delayed initiation of subcutaneous insulin therapy after failure of oral glucose-lowering agents in patients with Type 2 diabetes: a population-based analysis in the UK. Diabet Med. 2007;24:1412–1418. 

Hosomura N, et al. Decline of insulin therapy and delays in insulin initiation in people with uncontrolled diabetes mellitus. Diabet Med. 2017;34:1599–1602. 

Boeder S, et al. Practical Guidance for Healthcare Providers on Collaborating with People with Type 2 Diabetes: Advancing Treatment and Initiating Injectable Therapy. Diabetes Ther. 2023;14:425–446. 

Owens DR. Clinical Evidence for the Earlier Initiation of Insulin Therapy in Type 2 Diabetes. Diabetes Technol Ther. 2013;15:776–785. 

Brod M, et al. Psychological insulin resistance: patient beliefs and implications for diabetes management. Qual Life Res. 2009;18:23–32. 

Russell-Jones D, et al. Identification of barriers to insulin therapy and approaches to overcoming them. Diabetes Obes Metab. 2018;20:488–496. 

Ellis K, et al. Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis. BMC Family Practice. 2018;19:70. 

Kruger DF, et al. Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment. Diabetes Metab Syndr Obes. 2015;8:49–56. 

Brunton SA, et al. Overcoming Psychological Barriers to Insulin Use in Type 2 Diabetes. Clinical Cornerstone. 2006;8(S2):S19–S26. 

10.

Basu S, et al. Estimation of global insulin use for type 2 diabetes, 2018-30: a microsimulation analysis. Lancet Diabetes Endocrinol. 2019;7(S1):25–33. 

11.

Inzucchi SE, et al. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach. Diabetes Care. 2012;35:1364–1379.

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HQ24ICD00021, April 2024

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