Karter, Andrew J.Subramanian, UshaSaha, ChandanCrosson, Jesse C.Parker, Melissa M.Swain, Bix E.Moffet, Howard H.Marrero, David G.2013-08-162013-08-162010-04Karter, A. J., Subramanian, U., Saha, C., Crosson, J. C., Parker, M. M., Swain, B. E., ... & Marrero, D. G. (2010). Barriers to Insulin Initiation The Translating Research Into Action for Diabetes Insulin Starts Project. Diabetes Care, 33(4), 733-735.https://hdl.handle.net/1805/3432OBJECTIVE Reasons for failing to initiate prescribed insulin (primary nonadherence) are poorly understood. We investigated barriers to insulin initiation following a new prescription. RESEARCH DESIGN AND METHODS We surveyed insulin-naïve patients with poorly controlled type 2 diabetes, already treated with two or more oral agents who were recently prescribed insulin. We compared responses for respondents prescribed, but never initiating, insulin (n = 69) with those dispensed insulin (n = 100). RESULTS Subjects failing to initiate prescribed insulin commonly reported misconceptions regarding insulin risk (35% believed that insulin causes blindness, renal failure, amputations, heart attacks, strokes, or early death), plans to instead work harder on behavioral goals, sense of personal failure, low self-efficacy, injection phobia, hypoglycemia concerns, negative impact on social life and job, inadequate health literacy, health care provider inadequately explaining risks/benefits, and limited insulin self-management training. CONCLUSIONS Primary adherence for insulin may be improved through better provider communication regarding risks, shared decision making, and insulin self-management training.en-USType 2 DiabetesInsulinMedication AdherenceArticle