Background: As Type 2 diabetes (T2D) progresses, initiation of insulin therapy may become necessary to maintain glycemic management and prevent further health complications; however, therapeutic inertia in insulin initiation is common. This study aimed to understand perceptions of and barriers towards insulin therapy among people with T2D.

Methods: In December 2021, 1,939 non-insulin-using adults with T2D responded to an online questionnaire. Those whose doctor had previously discussed insulin therapy with them (n=143) completed a series of questions evaluating perceptions and barriers toward insulin on a 5-point Likert scale and indicated their preferred alternatives to starting insulin. Health and demographic information were collected.

Results: Nearly three quarters (73%) cited worries that once they start taking insulin, they would have to take it for the rest of their life. Over half (58%) felt that starting insulin would mean they were not adequately taking care of their diabetes, and 44% felt upset when their doctor first brought up insulin therapy. Concerns about weight gain (49%) , hypoglycemia (48%) , and hesitancy toward injections (43%) were also common. Only 22% felt confident that taking insulin would improve their diabetes management, and 69% believed they could improve their diabetes management without insulin. The most common preferred steps instead of starting insulin were altering diet (70%) and exercising more frequently (64%) ; 43% would rather start taking a new oral drug, while fewer would try a non-insulin injectable medication (22%) .

Conclusions: Insulin initiation may be associated with not only undesirable side effects, but also negative emotions and self-perceptions in adults with T2D. Many do not see insulin as necessary for improving their diabetes management and would prefer to make other changes. A better understanding of perceptions towards insulin therapy can help inform approaches to care.


J.Stevenson: Other Relationship; Abbott Diabetes, Ascensia Diabetes Care, Beta Bionics, Inc., Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, LifeScan, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc. E.Xu: Employee; dQ&A. E.Monroy-spangenberg: Employee; dQ&A, Stock/Shareholder; Senseonics. E.Ye: Employee; dQ&A. R.Wood: Other Relationship; Multiple companies and patient organizations (>10) .

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