Table 2.
Perceptions About Insulin Use and Experience Across Persistence Groups
| Overall | Continuers [A] | Interrupters [B] | Discontinuers [C] | p-value [A vs B] | p-value [A vs C] | p-value [B vs C] | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| (n = 154) | (n = 52) | (n = 52) | (n = 50) | ||||||||
| Respondent’s motivations for starting insulin, n (%) responding "Yes" | |||||||||||
| Encouragement from physician/healthcare provider | 101 | (65.6%) | 40 | (76.9%) | 30 | (57.7%) | 31 | (62.0%) | 0.04 | 0.10 | 0.66 |
| Improved glycemic control | 92 | (59.7%) | 26 | (50.0%) | 36 | (69.2%) | 30 | (60.0%) | <0.05 | 0.31 | 0.33 |
| Concern about developing other complications of diabetes | 42 | (27.3%) | 16 | (30.8%) | 13 | (25.0%) | 13 | (26.0%) | 0.51 | 0.59 | 0.91 |
| Preference for injections over pills | 10 | (6.5%) | 1 | (1.9%) | 4 | (7.7%) | 5 | (10.0%) | 0.17 | 0.08 | 0.68 |
| Inability to tolerate other antidiabetic medications | 4 | (2.6%) | 2 | (3.8%) | 1 | (1.9%) | 1 | (2.0%) | 0.56 | 0.58 | 0.98 |
| Other | 3 | (1.9%) | 2 | (3.8%) | 0 | (0.0%) | 1 | (2.0%) | 0.15 | 0.58 | 0.31 |
| Degree to which respondent felt views were considered, n (%) | 0.06 | 0.33 | 0.30 | ||||||||
| Not at all/slightly | 27 | (17.5%) | 5 | (9.6%) | 12 | (23.1%) | 10 | (20.0%) | |||
| Somewhat | 38 | (24.7%) | 16 | (30.8%) | 8 | (15.4%) | 14 | (28.0%) | |||
| Very/fully | 89 | (57.8%) | 31 | (59.6%) | 32 | (61.5%) | 26 | (52.0%) | |||
| Converted to 0–100, mean (SD) | 63.5 | (27.3) | 68.8 | (26.6) | 61.1 | (28.6) | 60.5 | (26.3) | 0.03 | 0.24 | 0.54 |
| Feelings when considering insulin, n (%) who agree/strongly agree | |||||||||||
| Reassurance that insulin would help manage diabetes | 122 | (79.2%) | 41 | (78.8%) | 45 | (86.5%) | 36 | (72.0%) | 0.30 | 0.42 | 0.07 |
| Fear of developing other complications of diabetes | 115 | (74.7%) | 40 | (76.9%) | 43 | (82.7%) | 32 | (64.0%) | 0.46 | 0.15 | 0.03 |
| Feeling that insulin indicated that diabetes was worsening | 108 | (70.1%) | 35 | (67.3%) | 39 | (75.0%) | 34 | (68.0%) | 0.39 | 0.94 | 0.43 |
| Sense of failure | 72 | (46.8%) | 21 | (40.4%) | 33 | (63.5%) | 18 | (36.0%) | 0.02 | 0.65 | <0.01 |
| Belief that insulin was not necessary | 46 | (29.9%) | 6 | (11.5%) | 23 | (44.2%) | 17 | (34.0%) | <0.01 | <0.01 | 0.29 |
| Concerns before starting insulin, n (%) who agree/strongly agree | |||||||||||
| Concern about becoming insulin-dependent | 99 | (64.3%) | 25 | (48.1%) | 38 | (73.1%) | 36 | (72.0%) | <0.01 | 0.01 | 0.90 |
| Concern that he/she would need to monitor blood glucose more often | 85 | (55.2%) | 21 | (40.4%) | 38 | (73.1%) | 26 | (52.0%) | <0.01 | 0.24 | 0.03 |
| Concern about ability to pay for insulin therapy | 83 | (53.9%) | 22 | (42.3%) | 38 | (73.1%) | 23 | (46.0%) | <0.01 | 0.71 | <0.01 |
| Fear of self-injection | 81 | (52.6%) | 17 | (32.7%) | 36 | (69.2%) | 28 | (56.0%) | <0.01 | 0.02 | 0.17 |
| Fear of making mistakes during self-injection | 81 | (52.6%) | 16 | (30.8%) | 38 | (73.1%) | 27 | (54.0%) | <0.01 | 0.02 | <0.05 |
| Worry about potential weight gain | 81 | (52.6%) | 20 | (38.5%) | 36 | (69.2%) | 25 | (50.0%) | <0.01 | 0.24 | <0.05 |
| Concern about carrying insulin around | 72 | (46.8%) | 20 | (38.5%) | 32 | (61.5%) | 20 | (40.0%) | 0.02 | 0.87 | 0.03 |
| Concern that he/she would need to visit physician/nurse more often | 71 | (46.1%) | 16 | (30.8%) | 34 | (65.4%) | 21 | (42.0%) | <0.01 | 0.24 | 0.02 |
| Worry about injecting insulin in front of other people | 69 | (44.8%) | 15 | (28.8%) | 31 | (59.6%) | 23 | (46.0%) | <0.01 | 0.07 | 0.17 |
| Worry about proper insulin storage | 64 | (41.6%) | 13 | (25.0%) | 31 | (59.6%) | 20 | (40.0%) | <0.01 | 0.11 | <0.05 |
| Worry that regular insulin use would interfere with daily activities | 64 | (41.6%) | 12 | (23.1%) | 32 | (61.5%) | 20 | (40.0%) | <0.01 | 0.07 | 0.03 |
| Worry that insulin would not provide glycemic control | 63 | (40.9%) | 12 | (23.1%) | 28 | (53.8%) | 23 | (46.0%) | <0.01 | 0.01 | 0.43 |
| Concern about potentially frequent hypoglycemia | 60 | (39.0%) | 9 | (17.3%) | 27 | (51.9%) | 24 | (48.0%) | <0.01 | <0.01 | 0.69 |
| Worry that scarring or bruising would result from injections | 55 | (35.7%) | 9 | (17.3%) | 29 | (55.8%) | 17 | (34.0%) | <0.01 | 0.05 | 0.03 |
Notes: Continuers had no gaps of ≥7 days in basal insulin treatment. Interrupters stopped basal insulin for ≥7 days within the first 6 months after initiation and since restarted basal insulin. Discontinuers stopped using basal insulin for ≥7 days within the first 6 months after initiation and had not restarted basal insulin by the time of the survey. P-values were calculated using t-tests for continuous variables and chi-square tests or Fisher’s exact tests for categorical variables. P<0.05 was considered statistically significant. Feelings when considering insulin were assessed on a 1–5 scale (1=“Not at all”, 2=“Slightly”, 3=“Somewhat”, 4=“Very”, 5=“Fully”). Concerns before starting insulin were assessed on a 1–5 level of agreement scale (1=“Strongly disagree”, 2=“Disagree”, 3=“Neither agree nor disagree”, 4=“Agree”, 5=“Strongly agree”).