Insulin non-persistence among people with type 2 diabetes: how to get your patients to stay on insulin therapy

ABSTRACT

Continuing use of medication is key to effective treatment and positive health outcomes, particularly in chronic conditions such as diabetes. However, in primary care, non-persistence (i.e. discontinuing or interrupting treatment) with insulin therapy is a common problem among patients with type 2 diabetes. To help primary care physicians manage patients who are non-persistent or likely not to be persistent, this review aimed to provide an overview of modifiable and non-modifiable factors associated with insulin non-persistence as well as practical strategies to address them. Data were extracted from published studies evaluating factors associated with non-persistence among patients with type 2 diabetes. A targeted literature review was performed using PubMed to identify recent studies (2000–2016) reporting measures of non-persistence with insulin therapy. Practical strategies to identify and prevent non-persistence were based on the authors’ direct experience in primary care. Non-modifiable factors associated with non-persistence included gender, age, prior treatments, and cost of therapy. Before/at insulin initiation, modifiable factors included patients’ perception of diabetes, preference for oral medication, and concerns/expectations about treatment complexity, inconvenience, or side effects. After initiation, modifiable factors included syringe use, difficulties during the first week of therapy, side effects, and insufficient glycemic control. Open-ended and patient-centered questions and a blame-free environment can help physicians identify, prevent, and reduce non-persistence behaviors. Possible questions to start a conversation with patients are provided. Effective physician-patient communication is essential to the management of diabetes. Primary care physicians should be familiar with the most common reasons for insulin non-persistence.

KEYWORDS:

• Diabetes
• insulin resistance
• primary care
• non-persistence
• chronic disease
• modifiable factors
• non-modifiable factors

Acknowledgments

Medical writing assistance was provided by Cinzia Metallo, PhD, an employee of Analysis Group, and was paid in full by Eli Lilly and Company.

Declaration of financial/other interests

M Perez-Nieves, I Hadjiyianni, and D Cao are employees of Eli Lilly and Company and may own stock or stock options. J Ivanova is an employee of Analysis Group, Inc., which has received consultancy fees from Eli Lilly and Company for this study. M Peyrot has received consultancy fees from Calibra, Eli Lilly, Johnson and Johnson, Novo Nordisk, Valeritas, and Analysis Group. T Garnero is a member of Eli Lilly’s speaker bureau for Basaglar but has yet to provide a lecture. N Davis has received consultancy fees from Eli Lilly and Company. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This study was funded by Eli Lilly and Company, Indianapolis, USA.