How can health professionals best support adults with type 2 diabetes who are concerned about starting insulin?

A new study published in Diabetes Therapy highlights strategies that adults with type 2 diabetes find helpful to overcome their concerns about starting insulin

By Dr Edith Holloway


Insulin is a very effective treatment for type 2 diabetes (T2D). However, around one quarter of adults with T2D report that they are not willing to inject insulin if recommended by their health professional. This can lead to a delay in effective treatment to manage blood glucose levels. This reluctance is also referred to as ‘psychological insulin resistance.

There are many reasons why someone might not want to change their medication or start injecting insulin. People with T2D report concerns and negative attitudes about insulin therapy, including a belief that insulin is not effective. They also report negative emotions, e.g. anxiety about injecting insulin, and feelings of guilt and self-blame about their diabetes management. Our previous research has shown that around half of Australians with T2D feel that starting insulin would be a punishment for, or consequence of, ‘failing’ to self-manage their diabetes. Yet, the reality is that, over time, T2D becomes more demanding and requires changes to the type and dose of medication(s). This is the natural course of T2D. For more information about insulin for T2D, and answers to commonly asked questions, check out the NDSS ‘Starting Insulin’ booklet.

EMOTION is a global study designed to identify strategies to overcome concerns about insulin. The researchers looked at 38 strategies used by health professionals to encourage adults with T2D to start insulin. Dr Elemer Balogh and colleagues analysed the EMOTION  survey data for 125 adults with T2D living in the UK who were ‘‘not willing’’ or only ‘‘slightly willing’’ to initiate insulin therapy when first asked by their health professional to do so. Their findings show:

  • 84% of participants found that a demonstration of the injection process was helpful for starting insulin.
  • 82% reported that their health professional highlighting the benefits of insulin – explaining that it is a natural substance the body needs – was helpful.
  • 81% reported that encouragement from their health professional to seek support and ask questions with injecting was helpful.

This study also found that the least helpful approach was when health professionals used an authoritarian communication approach (for example, repeatedly trying to convince adults with T2D to start insulin). When this strategy was used, participants were less likely to start insulin ,and more likely to discontinue insulin.

The findings from the EMOTION study highlight the important role of health professionals in supporting people with T2D who have concerns about starting insulin. Demonstrating the injection process and adopting a collaborative and supportive approach are practical strategies that health professionals can use to support people with T2D in overcoming the psychological barriers to insulin initiation.

Balogh E G, Perez-Nieves M, Cao D, Hadjiyianni I I, Ashraf N, Desai U, Snoek F J, Sturt J A. Key Strategies for Overcoming Psychological Insulin Resistance in Adults with Type 2 Diabetes: The UK Subgroup in the EMOTION Study. Diabetes Therapy. 2020 Jun 19. doi: 10.1007/s13300-020-00856-4. Online ahead of print.

If you (or someone you know) has concerns about starting insulin, check out the NDSS leaflet Concerns about starting insulin (for people with type 2 diabetes) or access the free booklet for people with T2D who are interested in learning more about insulin as a way of managing their diabetes.

To read more about psychological insulin resistance, read our other blogs here.