Février 2005
Diabetes Care. 2005 Feb;28(2):427-8.
Conclusion:
In this study of theoretical treatment choices among patients with type 2 diabetes failing to achieve target glycemic control on diet and/or OAD therapy, the availability of INH as a treatment option significantly increased the proportion of patients who would theoretically choose insulin overall. Patients were three times more likely to choose insulin therapy when INH was available, and INH was the most frequently chosen treatment option. In contrast, the aversion to injectable insulin was strong; despite a mean HbA1c of 9.1%, 4 of every 10 patients who were offered an option of standard therapy only chose to make no change to their treatment. The enhanced willingness of those offered the option of INH treatment to change to a more appropriate therapy increases the potential for achieving improved glycemic control and reduces the risks for microvascular, neuropathic, and macrovascular complications, as well as the associated morbidity, premature mortality, and increased cost.
Before the physician-patient interview, there was a marked contrast between the preferences expressed by patients and physicians for injectable insulin as a treatment option, with around half of the surveyed physicians preferring this option compared with the relatively low enthusiasm for this treatment among patients. Interestingly, patient rather than physician preferences appeared dominant, and low levels of initial reference for injectable insulin translated to low levels of actual choice of injectable insulin at the end of the study. The theoretical preference expressed by patients randomized to the availability of INH in our study may identify a means to overcome patient aversion to insulin therapy, and its availability may thus enable patients to act in accordance with the recommendations of their physicians.
Conclusion:
In this study of theoretical treatment choices among patients with type 2 diabetes failing to achieve target glycemic control on diet and/or OAD therapy, the availability of INH as a treatment option significantly increased the proportion of patients who would theoretically choose insulin overall. Patients were three times more likely to choose insulin therapy when INH was available, and INH was the most frequently chosen treatment option. In contrast, the aversion to injectable insulin was strong; despite a mean HbA1c of 9.1%, 4 of every 10 patients who were offered an option of standard therapy only chose to make no change to their treatment. The enhanced willingness of those offered the option of INH treatment to change to a more appropriate therapy increases the potential for achieving improved glycemic control and reduces the risks for microvascular, neuropathic, and macrovascular complications, as well as the associated morbidity, premature mortality, and increased cost.
Before the physician-patient interview, there was a marked contrast between the preferences expressed by patients and physicians for injectable insulin as a treatment option, with around half of the surveyed physicians preferring this option compared with the relatively low enthusiasm for this treatment among patients. Interestingly, patient rather than physician preferences appeared dominant, and low levels of initial reference for injectable insulin translated to low levels of actual choice of injectable insulin at the end of the study. The theoretical preference expressed by patients randomized to the availability of INH in our study may identify a means to overcome patient aversion to insulin therapy, and its availability may thus enable patients to act in accordance with the recommendations of their physicians.