Adherence to insulin therapy is often suboptimal. Understanding patients’ perspectives on drug adherence is essential for identification of barriers to therapy. The IDMPS is a global observational survey on the management of people with type 1 (T1D) and type 2 (T2D) diabetes in the developing world. In 2016-2017, participants were enrolled from 24 countries in the Middle East, South Asia, Eurasia, and Africa.In people with T1D (N=2000), 14% (273/1955) discontinued insulin for 1 month (median), without physician indication. The main reasons given were impact on social life, cost, fear of hypoglycemia, and lack of support (Table 1).

In people with T2D (N=2595), insulin discontinuation for ≥2 months (median), without physician indication, was reported by 13.4% and 13.8% of people treated with insulin alone (n=642) or with an oral antihyperglycemic drug + insulin (n=1895), respectively. The most common reasons for discontinuation included impact on social life, fear of hypoglycemia, lack of support, and cost. The pattern of insulin (eg, a definitive or temporary stop, or missed injection(s)) was not documented.

People with T1D and T2D share similar concerns regarding therapy. This calls for a multi-pronged strategy including patient education and access to therapy to improve treatment adherence and optimize outcomes.


P. Aschner: Other Relationship; Self; Sanofi. J.J. Gagliardino: Other Relationship; Self; Sanofi. H.M. Ilkova: Advisory Panel; Self; Abbott, Eli Lilly and Company, Novartis AG, Novo Nordisk A/S, Boehringer Ingelheim GmbH, Servier, Merck Sharp & Dohme Corp.. Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Medtronic, Roche Diabetes Care Health and Digital Solutions, Bilim İlac. F.J. Lavalle-Gonzalez: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Janssen Pharmaceuticals, Inc.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc.. Consultant; Self; Novo Nordisk Inc.. Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Research Support; Self; AstraZeneca. Advisory Panel; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Abbott. Speaker's Bureau; Self; Abbott.A. Ramachandran: None. G. Kaddaha: Other Relationship; Self; Sanofi. J. Mbanya: Advisory Panel; Self; GlaxoSmithKline plc.. Speaker's Bureau; Self; Novo Nordisk A/S, Sanofi, Servier.M.V. Shestakova: None. J. Chantelot: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. J.C. Chan: Consultant; Self; Bayer AG. Other Relationship; Self; Bayer AG. Consultant; Self; Sanofi. Other Relationship; Self; Sanofi, Eli Lilly and Company, Amgen Inc.. Consultant; Self; AstraZeneca, Merck & Co., Inc., Pfizer Inc.. Other Relationship; Self; Pfizer Inc.. Board Member; Self; Asia Diabetes Foundation. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; Merck Sharp & Dohme Corp.. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novartis AG, Eli Lilly and Company.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at