Willingness to initiate insulin among adults with type 2 diabetes in Australian primary care: Results from the Stepping Up Study

•Study explores 'willingness' to begin insulin among adults with T2DM in primary care.•Among those for whom insulin is clinically indicated, only 1 in 5 are 'very willing' to begin insulin.•Clinical factors and emotional wellbeing are not independently associated with 'willingness'.•Socioeconomic status and insulin appraisals are independently associated with 'willingness'.•Early acknowledgement and discussion of attitudinal barriers may improve insulin receptiveness.

AimsTo determine 'hypothetical willingness' to initiate insulin, and identify associated factors, among adults with type 2 diabetes (T2DM) in primary care for whom insulin is clinically indicated.MethodsEligible participants were adults with T2DM with an HbA1c ≥7.5% (58 mmol/mol) and prescribed maximum oral hypoglycaemic agents. A total of 261 participants were recruited from 74 Victorian general practices: mean age 62 ± 10 years; 39% (n = 103) women; diabetes duration 10 ± 6 years; HbA1c 9.0 ± 1.3% (75 ± 14 mmol/mol). Data collected by the Stepping Up Study: demographic and clinical characteristics, 'willingness' to initiate insulin, insulin appraisals, depressive symptoms, and diabetes-related distress. A multinomial regression investigated predictors of 'willingness'.ResultsNineteen percent (n = 50) were 'very willing' to initiate insulin, if recommended. The final regression model (R2 = .44, χ2(12) 145.91, p < .001) demonstrated higher socioeconomic status and less negative attitudes to insulin were associated with increased willingness to initiate insulin.ConclusionsAmong adults with T2DM for whom insulin is clinically indicated, only one in five are 'very willing' to begin insulin therapy. Independent of demographics, clinical factors and emotional wellbeing, insulin appraisals were associated with 'willingness'. This study highlights the importance of addressing attitudinal barriers to insulin therapy among adults with T2DM in primary care to improve insulin receptiveness.