Barriers to insulin injection therapy: patient and health care provider perspectives

Diabetes Educ. Nov-Dec 2009;35(6):1014-22. doi: 10.1177/0145721709345773.


Objective: To compare patients' perceptions of injection-related problems with clinicians' estimates of those problems.

Methods: Data were obtained through 2 Internet surveys, one of US adults self-identified as taking insulin to treat diabetes and the second of health care professionals who treat people with diabetes who inject insulin, including primary care physicians, endocrinologists, and diabetes educators.

Results: A substantial majority of patients would like to reduce the number of injections they take each day; almost half said that they would be more likely to take their insulin injections regularly if a product were available to ease the pain. A much smaller proportion of patients reported that (1) injections were a serious burden, (2) they were dissatisfied with the way they took insulin, (3) injections had a substantial negative impact on quality of life, (4) they skipped injections they should take, or (5) injection-related problems affected the number of injections they were willing to take. Half of the patients said they mentioned injection-related problems to their provider; a similar number reported that their providers had not given them a solution to problems with injection-related pain and bruising. Although awareness of products to ease injection pain was high among providers (especially diabetes educators), this information was not effectively transmitted to patients.

Conclusions: Patients should be encouraged to discuss their injection-related concerns, and providers should regularly ask about injection-related problems. Providers should offer patients information about tools to reduce injection-related worries, preferably by having them available to show and demonstrate.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude*
  • Educational Status
  • Endocrinology
  • Ethnic Groups
  • Female
  • Health Educators / psychology
  • Health Surveys
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / therapeutic use
  • Income
  • Injections, Subcutaneous / psychology*
  • Insulin / administration & dosage
  • Insulin / therapeutic use*
  • Internet
  • Male
  • Middle Aged
  • Perception
  • Physicians / psychology
  • United States


  • Hypoglycemic Agents
  • Insulin