Insulin therapy initially declined and delayed by an average of two years

Alexander Turchin, MD, MS, director of quality in diabetes in the division of endocrinology, diabetes and hypertension at BWH, who led the study, was inspired by his own practice as an endocrinologist treating diabetic patients.

"Unfortunately this isn't uncommon, patients being reluctant to start insulin therapy when it's recommended," says Turchin. "Many clinicians have encountered this phenomenon, but until our study it was not known just how prevalent delays in insulin initiation are. As physicians, we need to make sure that these patients are making fully informed decisions and that we understand their perspective to ensure they are treated effectively."

To find this information, investigators designed a computer program to analyze electronic physician notes of BWH patients from 2000 to 2014 to identify patients with type 2 diabetes who initially declined insulin therapy. Of the 3,295 patients included in the analysis, nearly one third declined a physician's advice to begin insulin at the time the recommendation was made. People who initially declined, but ultimately accepted the recommendation to start insulin, on average, started the insulin therapy more than two years later, during which time their blood glucose levels had increased further.

Diabetes is increasingly common in the United States, with over 30 million people affected. The high prevalence of decline of insulin therapy by patients that the study found suggests, per the researcher's estimations, that it could mean over 1 million people in the U.S. find themselves in this situation. The team notes further investigation is needed to determine the reasons, risk factors and long-term outcomes of these patients' important clinical decision.