- With type 2 diabetes, the insulin function is impaired. The body is unable to properly metabolize sugar, or glucose, in the blood.
- A new study found that more than 40 percent of people with type 2 diabetes initially turn down their doctor’s recommendation of insulin therapy.
- Compared with those who began insulin therapy, people who refused had worse glycemic control, and it took them longer to reach healthier blood sugar levels.
Medications, lifestyle changes, and in more serious cases, insulin therapy can manage the condition.
But a significant portion of people with diabetes often initially decline insulin therapy, according to new research from Brigham and Women’s Hospital.
The study, which published in Diabetic Medicine on Thursday, found that more than 40 percent of people with type 2 diabetes turn down their doctor’s recommendation of insulin therapy.
But those who delay insulin therapy face challenges.
Compared with those who began insulin therapy, people who refused had worse glycemic control, and it took them longer to reach healthier blood sugar levels.
Researchers evaluated 15 years of health data from 5,307 adults with type 2 diabetes whose doctors had recommended they try insulin therapy.
Of the group, 2,267 people — or 42.7 percent — declined insulin therapy, and, in the years that followed, had worse glycemic control than those who started it.
Older adults were more likely to decline insulin therapy, as were those already taking other diabetes medications that weren’t insulin.
According to the researchers, the findings imply that delaying insulin therapy could have severe health consequences and shorten a person’s life span.
It also highlights the need to improve how various treatment options are discussed with people with diabetes, all while considering each individual’s preferences and risk factors.
“These findings highlight the need to improve our understanding of the relationship of this common but poorly explored clinical phenomenon to blood glucose control and ultimately diabetes complications,” the researchers state in the study.
Insulin therapy can be lifesaving
In people without diabetes, the pancreas secretes the hormone insulin, which regulates blood sugar levels. Insulin is what prevents excessively high or extremely low levels of sugar in the blood.
With type 2 diabetes, the insulin function is impaired, and the body is unable to properly metabolize sugar, or glucose, in the blood.
“Patients with diabetes either don’t make enough insulin or they make insulin but [develop] resistance to that insulin, meaning that insulin doesn’t work as well as it should,” said Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City.
Oftentimes, people with diabetes need to take insulin therapy to help the body clear excess sugar from the blood before complications arise.
“It is essential to get blood sugars under good control because high sugars can lead to fatigue, excessive urination and thirst, and unintentional weight loss as well as hospitalization or death in the most severe cases,” said Dr. Patricia R. Peter, an endocrinologist with the Diabetes Center at Yale Medicine.
High blood sugar levels can also damage nerves, kidneys, vision, and blood vessels — which can trigger organ failure, a heart attack, or stroke.
In short, insulin therapy can be lifesaving for people with diabetes.
Cost, side effects, and stigma may turn off people to insulin therapy
It’s unclear why so many people with diabetes decline insulin therapy.
According to Peter, many may fear the stigma linked to insulin therapy.
“Some people equate insulin treatment with some of the most dreaded complications of diabetes, erroneously thinking that insulin will lead to a worsening of diabetes rather than realizing that it is often a necessary treatment when the disease itself is uncontrolled,” Peter said.
Others believe insulin is a “nuclear option,” Peters adds — only necessary for those whose condition is very advanced and potentially irreversible.
They may opt for an alternative treatment first.
“Alternative therapies are not at all as effective as insulin therapy in lowering glucose,” Sood said, adding that these treatments, like cinnamon supplements, inositol, and berberine, aren’t a substitute for insulin.
There’s also the side effects people hear about: weight gain, the self-injections, low blood sugar (hypoglycemia).
It may seem simpler to make some lifestyle changes first, and see whether that helps.
“In my experience, some people with diabetes, when they are first diagnosed, are eager to make lifestyle changes to address the issue head-on in that manner. These patients may decline treatment at first,” Sood said.
And then there’s the high cost.
It’s estimated that the average cost of insulin tripled between 2002 and 2013. The rising prices have caused some Americans to ration their insulin, or frantically sell their goods for cash to afford the therapy.
Whatever the reasons may be, it’s clear something needs to change to ensure people are getting the treatment they need to survive.
There’s a significant need to improve how treatment options are discussed with people who have type 2 diabetes and ensure they’re making fully informed choices.
The best approach, the researchers say, is to weigh the pros and cons of all the different treatment options and customize a plan that’ll fit with their preferences along with their personal risks and benefits.
In many cases, though, insulin therapy can be the difference between life and death.
The bottom line
New research has found that more than 40 percent of people with type 2 diabetes turn down their doctor’s recommendation of insulin therapy.
And those who delay insulin therapy are worse off. Compared with those who began insulin therapy, people who refused had worse blood sugar control, and it took them longer to reach healthier blood sugar levels.
The findings show we need to improve how diabetes treatment options are discussed and ensure people with type 2 diabetes are making fully informed choices.
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