Potential risk factors in skipping insulin injections

More than half of people with diabetes who take insulin injections to control their diabetes say they have intentionally skipped an injection, with one-fifth of them reporting that they do so "sometimes" or "often," according to a study being published this month in Diabetes Care.

Using an Internet survey of more than 500 U.S. adults, the study found that 57% of survey respondents with either type 1 or type 2 diabetes purposefully failed to take their insulin shots at least occasionally. It also found that older patients, those who were disabled, those who followed a healthy diet and those with higher household incomes were more likely to take their shots at the frequency prescribed. Students, those with type 2 diabetes, and those who took more injections were more likely to skip them. Additionally, those who perceived more injection-related problems, such as interference with daily activities and injection pain and embarrassment, were more likely to skip injections.

"Intentionally skipping insulin injections may be more common than clinicians think," said lead researcher Mark Peyrot, PhD, Department of Sociology, Loyola University Maryland. "It's important for physicians and other health care professionals to be aware of potential risk factors, especially for patients who report injection-related problems. We hope that in the future doctors will work closer with patients to determine their individual needs, so that they can better plan activities to facilitate patients' adherence with their treatment regimens."

In an accompanying editorial, researchers from the Department of Psychiatry at Harvard Medical School and the Joslin Diabetes Center pointed out that U.S. physicians often delay insulin therapy for patients and that Americans frequently resist such treatments. "Physicians need to identify and address patients' beliefs about insulin and examine their own reluctance to initiate insulin treatment," they wrote.

Risk factors for failing to comply with insulin regimens differed between those who had type 1 and those who had type 2 diabetes. The researchers found diet non-adherence to be a more prominent risk factor for missing injections in type 1 patients, whereas younger age, lower income, and perceived pain and embarrassment were more prominent as risk factors for people with type 2.

More than 25 percent of people with diabetes must inject themselves with insulin on a daily basis. All people with type 1 diabetes and many people with type 2 diabetes need insulin to manage their disease and to prevent or slow the progression of dangerous complications.