Cultural Differences and Considerations When Initiating Insulin
Diabetes remains the seventh leading cause of death in the United States and is associated with many complications, including both microvascular and macrovascular comorbidities (1). In 2013, average medical expenditures among people diagnosed with diabetes were 2.3 times higher than among those without diabetes. According to the 2014 National Diabetes Statistics Report, 1.4 million Americans are diagnosed with diabetes annually (1). Although diabetes affects people from different races and ethnic backgrounds, the rates of diagnosed diabetes continue to be higher in ethnic minority groups such as non-Hispanic blacks, Hispanics, and Asian Americans, among others (1,2).
The U.K. Prospective Diabetes Study demonstrated that maintaining diabetes control with an A1C of ∼7% during the first 10 years after diagnosis decreases the risk of microvascular complications for people with type 2 diabetes (3). Among the treatment options available for diabetes, insulin is the mainstay of therapy for type 1 diabetes and is also recommended in newly diagnosed type 2 diabetes (4,5).
Despite its effectiveness and guideline recommendations for its use, insulin remains underutilized among adults with diagnosed diabetes in the United States (3,6,7). Between 1997 and 2011, the percentage of adults who reported taking only insulin to treat their diabetes decreased from 26 to 17.8% (1). In contrast, the percentage of people taking only oral medications for diabetes increased from 42.1 to 50.3%. Even with the addition of new insulin analogs for the treatment of diabetes, the usage rate of oral diabetes medications among adults with type 2 diabetes has remained almost three times higher than that of insulin (50.3 vs. 17.8%) (1). The usage rates of any diabetes medications by Hispanics, non-Hispanic blacks, and whites are similar; however, the usage rate of insulin among ethnic minority populations continues to be lower than …