Differences in physician and patient perceptions about insulin therapy for management of type 2 diabetes: the DAWN Japan study

Abstract

Objective:

To better understand patient resistance to initiation of insulin therapy, this study examined the perception gap concerning initiation of insulin therapy between individuals with type 2 diabetes and their physicians by using data from the DAWN Japan study.

Methods:

The DAWN Japan study is a multi-center, questionnaire-based survey, conducted between 2004–2005. Patients recommended to start insulin therapy (n = 148) answered a questionnaire by rating degree of agreement with 16 statements concerning insulin therapy on a 5-point scale (1: strongly disagree to 5: strongly agree). Ratings of 1 and 2 were categorized as ‘disagree’ with a statement, and 3, 4, and 5 as ‘agree’. Their attending physicians (n = 68) selected statements which could be associated with patient’s concerns about insulin therapy.

Results:

Nearly all the patients agreed with the statements ‘I don’t want to inject myself for the rest of my life’ (95%), and ‘I don’t want to be bothered with doing injections’ (90%); fewer than half agreed with ‘My friendships may suffer’ (46%), and ‘I don’t understand why insulin is necessary for me’ (45%). Estimation by the physicians and the actual perceptions patients reported differed significantly for 13 statements. Physicians seemed to particularly under-estimate the impact associated with social aspects of insulin use (e.g., ‘I don’t want to be different from others’, 55% patients vs 7% physicians). On the contrary, the statement ‘Injections are painful’ was the only concern over-estimated by the physicians.

Conclusions:

It was demonstrated that differences in perceptions regarding insulin therapy exist between physicians and patients, particularly in terms of social impacts. The data, obtained in 2004, may not precisely reflect the present situation, but still represents a barrier to insulin therapy widely held by patients and physicians. These results suggest that appropriate understanding of patients’ concerns about insulin therapy is important to encourage timely insulin initiation.

Keywords::

• Psychological insulin resistance
• Type 2 diabetes
• Insulin
• Patient’s perception
• Physician’s perception

Transparency

Declaration of funding

This study was funded by Novo Nordisk A/S.

Declaration of financial/other relationships

Each author has disclosed the following relevant relationships. NY has disclosed being on the speaker’s bureau for Sanofi, Novo Nordisk A/S, and MSD. HI has disclosed being on the speaker’s bureau and receiving honoraria for speakers from NovoNordisc A/S, Eli Lilly, and Sanofi. NT has disclosed receiving payment for lecture from Novo Nordisc A/S, and YI has disclosed being on the speaker’s bureau for Novo Nordisk A/S. CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

We are deeply grateful for the co-operation of the participating physicians and their patients, as well as to Dr Mark Peyrot, PhD, of Loyola University Maryland, MD, who provided helpful advice to the authors for preparing this report. The support of Dr Jo Oswald in manuscript preparation is also acknowledged. We also appreciate the following members of the DAWN Japan advisory panel:

Representative co-ordinator: Yasuhiko Iwamoto (Professor Emeritus, Tokyo Women’s Medical University).

Co-ordinators: Naoko Tajima (Jikei University: Diabetes/Metabolism/Endocrinology) (Present affiliation: Professor Emerita, Jikei University); Hitoshi Ishii (Tenri Hospital: Endocrinology) (Present affiliation: Nara Medical University: Department of Diabetology); Shin’ichi Oikawa (Nippon Medical School Hospital, III Internal Medicine Department); Masato Odawara (Tokyo Medical University, III Internal Medicine Department); Yasushi Saito (Chiba University Graduate School of Medicine, Clinical Cell Biology and Medicine); Hiroaki Seino (Seino Internal Medical Clinic); Yoichi Hayashi (Nihon University School of Medicine, III Internal Medicine Department); Hirofumi Makino (Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kidney/Immunology/Endocrinology); Narihito Yoshioka (Hokkaido University Graduate School of Medicine, Pathological Internal Medicine II Department) (Present affiliation: Sapporo Medical Center NTT EC); Tsutomu Yamasaki (Tokyo University Graduate School, Clinical Bioinformatics Unit).

Statistical analysis advisor: Junji Kishimoto (Kyushu University Digital Medicine Initiative, Digital Organ Unit).