Insulin for Type 2 Diabetes Mellitus: Separating the Myths from the Facts

Background: Reluctance to use insulin is a well-established problem among patients with type 2 diabetes mellitus (DM). Many of the concerns that prompt patients to resist insulin are rooted in myths that arose because of the medical profession's difficult history with this medication.Objectives: The goals of this article were to articulate those myths, describe their impact on patient and clinician reasoning, and explain how clinicians can reassure patients and help them make a more informed choice about insulin therapy.Methods: Materials used for this article were identified through a search of PubMed for the years 1993 to 2007. English-language articles were selected using the search terms diabetes mellitus, psychological insulin barriers, and clinical inertia.Results: There are patient- and physician-specific barriers to insulin initiation that providers must be aware of to successfully counsel patients. Physician issues include worries regarding the effect insulin initiation in patients will have on practice resources (eg, impact patient crises have during initial stages of insulin therapy, concern there is inadequate time or personnel to teach insulin therapy); fear that patients will become angry, alienated, or leave the practice; and concern about the potential for patient hypoglycemia and weight gain. Patient-centered issues focus on the fear of weight gain, social embarrassment/stigma, hypoglycemia, lifestyle changes/restrictions, painful injections, and feelings of failure and guilt that treatment has progressed to needing insulin. Clinicians can alleviate many patient concerns by becoming aware of the personal and social dimensions of insulin therapy. Numerous strategies are available for the clinician to use for successful implementation of insulin therapy in patients with type 2 DM.Conclusion: By investigating the new, simpler, more straightforward algorithms for initiating insulin and using them in patient care, it will be possible to help patients make an informed decision when the time comes to start insulin therapy.