Successful Health Care Provider Strategies to Overcome Psychological Insulin Resistance in U.S. and Canada
Authors: TANG TRICIA S. , HESSLER DANIELLE M. , POLONSKY WILLIAM , FISHER LAWRENCE , HADJIYIANNI IRENE , CAO DACHUANG , REED BEVERLY , KALIRAI SAMANEH , IRANI TANYA , IVANOVA JASMINA I. , DESAI URVI , PEREZ-NIEVES MAGALY 
Published: June 2018

About 30% of patients with type 2 diabetes (T2D) are reluctant to initiate basal insulin when recommended. In the EMOTION study, we surveyed T2D adults from seven countries, who initiated basal insulin ≤36 months ago, had T2D for ≥12 months before basal insulin initiation, and were initially reluctant to begin insulin but were using insulin at the time of the survey, to identify key healthcare providers’ (HCPs) actions that influenced their decision to start insulin. Patients completed a 30-minute online survey that included a newly-designed 38-item questionnaire (Psychological Insulin Resistance [PIR] Action Survey; developed from 58 patient and HCP interviews in 6 of the 7 countries) aimed at identifying occurrence and helpfulness of HCP actions for the decision to begin basal insulin. Here we describe separately findings from 120 patients in U.S. and 74 patients in Canada. The most helpful HCP actions, conditional on occurring, were patient-centric approaches to improve understanding of the injection process ("My HCP walked me through the whole process of exactly how to take insulin" [helped moderately or a lot-U.S.: 79%; CAN: 83%]) and alleviate concerns ("My HCP encouraged me to contact his/her office immediately if I ran into any problems or had questions after starting insulin" [U.S.: 76%; CAN: 82%]). Items reported to be the least helpful, conditional on occurrence, included authoritarian statements and referrals to other sources. In U.S., the least helpful HCP action was: "My HCP warned me that he/she could not be responsible for what might happen if I did not start insulin soon" (43% helped moderately or a lot). In Canada, the least helpful action was: "My HCP helped me meet other people who had already been taking insulin for a while" (50%). The study provides the first evidence pointing to successful strategies for overcoming PIR, and is a critical step towards the design of effective intervention protocols for HCPs.

Disclosure
T.S. Tang: Consultant; Self; Eli Lilly and Company. D.M. Hessler: Consultant; Self; Eli Lilly and Company. W. Polonsky: Consultant; Self; Abbott, AstraZeneca, Dexcom, Inc., Sanofi, Novo Nordisk Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Servier, Ascensia Diabetes Care, Merck & Co., Inc., MannKind Corporation, Glooko, Inc., Roche Diabetes Care Health and Digital Solutions. L. Fisher: Consultant; Self; Eli Lilly and Company, Abbott, Merck & Co., Inc. I. Hadjiyianni: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. D. Cao: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. B. Reed: None. S. Kalirai: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. T. Irani: Employee; Self; Eli Lilly and Company. J.I. Ivanova: Other Relationship; Self; Eli Lilly and Company. Employee; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc. U. Desai: Other Relationship; Self; Eli Lilly and Company, AstraZeneca. M. Perez-Nieves: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.