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.

“When my doctor told me I needed insulin, I said: ‘My God! Insulin is a sign that things aren’t going well.’

He just gave me the prescription. And that was that.

My advice to doctors is to take time to win patients’ trust and to say that it isn’t a personal failure to need insulin.”

Do you know a patient like Zilda?

Help patients like Zilda overcome their reservations about insulin therapy by addressing their concerns.³ Reassure them that starting on insulin is not a ‘personal failure’ but offers them an effective therapy that has helped people reduce the progression of their type 2 diabetes.^3,11

“Weight gain was a worry for me … hypoglycaemia was also a big concern …

… but the doctor explained that my body would give me signals that I’m running low on sugars – and what I should do if that happens. So far we’ve not seen any weight gain.

My advice to doctors is to be very open and very clear."

Do you know a patient like Mitesh?
Like Mitesh, patients can have different worries when insulin is first suggested. And before you can reassure your patients, it helps to understand their reasons for insulin inertia.

“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.”

Do you know a patient like Yan? 
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.

“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.”

Do you know a patient like José Luis?
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.^3,12

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 masterclass videos.

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’.

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.

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'.

^*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.

Wong J. The introduction of insulin in type 2 diabetes mellitus. Aust Fam Physician. 2015;44:278–283.

12.

Inzucchi SE, et al. The introduction of insulin in type 2 diabetes mellitus. Aust Fam Physician. 2015;44:278-283.

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HQ24ICD00077, August 2024

For healthcare professionals only