Reasons for Discontinuation of Insulin Therapy—Results from the International Diabetes Management Practices Study (IDMPS)
Authors: ASCHNER PABLO , GAGLIARDINO JUAN J. , ILKOVA HASAN M. , LAVALLE-GONZALEZ FERNANDO J. , RAMACHANDRAN SR., AMBADY , KADDAHA GHAIDA , MBANYA JEAN CLAUDE , SHESTAKOVA MARINA V. , CHANTELOT JEAN-MARC , CHAN JULIANA C. 
Published: June 2018

Adherence to insulin therapy is often suboptimal. Understanding patients’ perspectives on drug adherence is essential for identification of barriers to therapy. The IDMPS is a global observational survey on the management of people with type 1 (T1D) and type 2 (T2D) diabetes in the developing world. In 2016-2017, participants were enrolled from 24 countries in the Middle East, South Asia, Eurasia, and Africa.In people with T1D (N=2000), 14% (273/1955) discontinued insulin for 1 month (median), without physician indication. The main reasons given were impact on social life, cost, fear of hypoglycemia, and lack of support (Table 1).
In people with T2D (N=2595), insulin discontinuation for ≥2 months (median), without physician indication, was reported by 13.4% and 13.8% of people treated with insulin alone (n=642) or with an oral antihyperglycemic drug + insulin (n=1895), respectively. The most common reasons for discontinuation included impact on social life, fear of hypoglycemia, lack of support, and cost. The pattern of insulin (eg, a definitive or temporary stop, or missed injection(s)) was not documented.
People with T1D and T2D share similar concerns regarding therapy. This calls for a multi-pronged strategy including patient education and access to therapy to improve treatment adherence and optimize outcomes.

Disclosure
P. Aschner: Other Relationship; Self; Sanofi. J.J. Gagliardino: Other Relationship; Self; Sanofi. H.M. Ilkova: Advisory Panel; Self; Abbott, Eli Lilly and Company, Novartis AG, Novo Nordisk A/S, Boehringer Ingelheim GmbH, Servier, Merck Sharp & Dohme Corp.. Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Medtronic, Roche Diabetes Care Health and Digital Solutions, Bilim İlac. F.J. Lavalle-Gonzalez: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Janssen Pharmaceuticals, Inc.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc.. Consultant; Self; Novo Nordisk Inc.. Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Research Support; Self; AstraZeneca. Advisory Panel; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Abbott. Speaker's Bureau; Self; Abbott.A. Ramachandran: None. G. Kaddaha: Other Relationship; Self; Sanofi. J. Mbanya: Advisory Panel; Self; GlaxoSmithKline plc.. Speaker's Bureau; Self; Novo Nordisk A/S, Sanofi, Servier.M.V. Shestakova: None. J. Chantelot: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. J.C. Chan: Consultant; Self; Bayer AG. Other Relationship; Self; Bayer AG. Consultant; Self; Sanofi. Other Relationship; Self; Sanofi, Eli Lilly and Company, Amgen Inc.. Consultant; Self; AstraZeneca, Merck & Co., Inc., Pfizer Inc.. Other Relationship; Self; Pfizer Inc.. Board Member; Self; Asia Diabetes Foundation. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; Merck Sharp & Dohme Corp.. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novartis AG, Eli Lilly and Company.