Impact of patient attitudes and beliefs to insulin therapy upon initiation, and their attitudinal changes after initiation: the DAWN Japan study

Abstract

Objective As a part of the Diabetes Attitudes, Wishes and Needs (DAWN) Japan study, a multi-center, questionnaire-based survey conducted between 2004 and 2005, this analysis aimed to (1) explore patients’ attitudes and beliefs contributing to their decision to start insulin therapy, and (2) assess the changes in their attitudes and beliefs after actual initiation.

Methods Insulin-naive patients with type 2 diabetes who were recommended to start insulin therapy (n = 149) were invited to answer a 21-item questionnaire consisting of five clusters assessing their attitudes and beliefs toward insulin therapy. The questionnaire was administered twice: first upon insulin recommendation, and then 1 month after insulin initiation for those who started and 4 months after for those who did not.

Results Of 130 patients included in the analysis, 74 patients (56.9%) started insulin therapy. ‘Negative image of injections’ and ‘Positive image toward insulin therapy’ were significantly associated with patient decision to start insulin therapy (odds ratios [95% CI]: 0.49 [0.32–0.76] and 2.58 [1.51–4.42], respectively). After insulin initiation, ‘Negative image of injections’, ‘Positive image toward insulin therapy’, ‘Feelings of guilt regarding diabetes self-management’, and ‘Negative image toward insulin therapy’ decreased significantly (P < 0.001 for all). ‘Social/interpersonal effects’ did not change after insulin initiation.

Conclusions This study demonstrated that patients who started insulin therapy were less likely to have negative images of injections and more likely to have positive images toward insulin therapy. Starting insulin therapy did not deteriorate the patient’s overall impression of therapy. The key limitation is the relatively small sample size (n = 130). The results suggest that education about the benefits of insulin therapy may help patients who are not ready to initiate insulin overcome their barrier to early insulin initiation and practical support may help those who have already started therapy to maintain its use.

Keywords:

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

Declaration of funding

This study was funded by Novo Nordisk A/S.

Declaration of financial/other relationships

M.O. has disclosed that he has received speakers’ bureau fees from Sanofi KK, Novartis Pharma KK, Eli Lilly Japan KK, and Novo Nordisk Pharma Ltd. H.I. has disclosed that he serves as a consultant/advisor to Novo Nordisk Pharma Ltd, and has received honoraria from Novo Nordisk Pharma Ltd, Sanofi KK, Eli Lilly Japan KK, AstraZeneca KK, Takeda Pharmaceutical Company Limited, and Novartis Pharma KK. N.T. has disclosed that she serves as a consultant/advisor to Merck Sharp & Dohme Corp., Takeda Pharmaceutical Company Limited, Eli Lilly Japan KK, Nippon Boehringer Ingelheim Co. Ltd, Novo Nordisk Pharma Ltd, Novartis Pharma KK, and Abbott Japan Co. Ltd. Y.I. has disclosed that he has received speakers’ bureau fees from Ono Pharmaceutical Co. Ltd, Kowa Pharmaceutical Co. Ltd, Novartis Pharma KK, Eli Lilly Japan KK, Novo Nordisk Pharma Ltd, Sanofi KK, Taisho Pharmaceutical Co. Ltd, and Eisai Co. Ltd.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We are deeply grateful for the cooperation of the participating physicians and their patients, as well as to Dr. Mark Peyrot PhD of Loyola University Maryland, USA, who provided helpful advice to the authors for preparing this report. The support of Dr. Jo Oswald in manuscript preparation is also acknowledged. Also, support for manuscript preparation was provided by Clinical Study Support, Inc. We appreciate the following members of the DAWN Japan advisory panel. Representative coordinator: Yasuhiko Iwamoto (Professor Emeritus, Tokyo Women’s Medical University) (present affiliation: The Institute for Adult Diseases, Asahi Life Foundation). Coordinators: Naoko Tajima (Jikei University) (present affiliation: Professor Emerita, Jikei University School of Medicine), Hitoshi Ishii (Tenri Hospital, Endocrinology) (present affiliation: Nara Medical University, Department of Diabetology), Shinichi Oikawa (Nippon Medical School Hospital, III Internal Medicine Department), Masato Odawara (Tokyo Medical University, Department of Diabetology, Metabolism, and Endocrinology), 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).

Previous presentation: Ueno H, Ishii H, Oikawa S, et al. DAWN JAPAN study 2005: (4) The relationship between readiness to insulin therapy and actual initiation of the therapy in patients with type 2 diabetes (in Japanese). Presented at 49th Annual Meeting of the Japan Diabetes Society, 25–27 May 2006, Tokyo, Japan. Seino H, Ishii H, Oikawa S, et al. DAWN JAPAN study 2005: (5) Psychological change in patients with type 2 diabetes who started insulin therapy (in Japanese). Presented at 49th Annual Meeting of the Japan Diabetes Society, 25–27 May 2006, Tokyo, Japan. Odawara M, Ishii H, Oikawa S, et al. Changes in attitude and treatment satisfaction after initiation of insulin treatment among Japanese patients with type 2 diabetes. Presented at Therapeutic Patient Education 2006, 27–30 April 2006, Florence, Italy.