Clinical and psychosocial factors associated with “willingness to start insulin” among adults with type 2 diabetes in primary care: Stepping Up Study — ASN Events
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Clinical and psychosocial factors associated with “willingness to start insulin” among adults with type 2 diabetes in primary care: Stepping Up Study (#319)

Elizabeth Holmes-Truscott 1 2 , Jane Speight 1 2 3 , Irene Blackberry 4 5 , David O'Neal 6 , John Furler 4
  1. The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Vic, Australia
  2. School of Psychology, Deakin University, Burwood, Vic, Australia
  3. AHP Research, Hornchurch, Essex, UK
  4. Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
  5. La Trobe University, Wodonga, Victoria, Australia
  6. Department of Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia

Previous research has explored attitudes to insulin and hypothetical “willingness to start insulin” therapy among adults with type 2 diabetes (T2D). However, few studies have explored these issues in a primary care setting among those for whom insulin was clinically indicated. We examined factors associated with “willingness to start insulin” using baseline data from participants in the Stepping Up Study.
Eligible participants were adults with T2D, with HbA1c in the past 6 months above target (>7.5%; 53 mmol/mol), taking maximum oral hypoglycaemic agents who were insulin naïve. A total of 261 adults attending 74 general practices in Victoria participated: mean age 62±10 years; 39% (103) women; diabetes duration 10±6 years; HbA1c 9.0±1.3% (74.5±13.9). Data were collected on socioeconomic status (SEIFA), “willingness to start insulin” (single item), attitudes to insulin (measured using ITAS and ATIS6), depressive symptoms (PHQ-9), and diabetes-related distress (PAID). A stepwise multinomial regression was conducted to identify predictors of “willingness”.
Nineteen percent (50/261) of participants were ‘very willing’ to initiate insulin if recommended. No clinical or demographic variables differed by “willingness”, except socioeconomic status (p=.001). PHQ-9 and PAID scores both differed by “willingness” (p=<.05), but were not significant predictors. The final regression model (R2=.44, χ2 (12) 146.98, p<.001) demonstrated lower socioeconomic status and more negative attitudes to insulin were associated with participants being ‘not at all willing’ or ‘not very willing’ to start insulin, versus being ‘very willing’.
Our findings demonstrate that among adults with T2D for whom insulin is clinically indicated, only one in five are ‘very willing’ to begin insulin therapy. Attitude towards insulin therapy and lower socioeconomic status are independently associated with “willingness to start insulin”. This study highlights the importance of addressing attitudes towards insulin therapy among adults with T2D attending general practice.