The recent article by Peyrot et al. (1) concerning the attitudes of both patients and providers with respect to insulin therapy raises some potentially important issues about barriers to an important treatment in diabetes. However, their statement that “U.S. physicians were significantly more disposed to delay insulin therapy than physicians in all other countries … ” (1) appears to contradict differences in cited prescribing patterns between type 2 diabetic patients in America, Australia, and Europe. For example, results from the National Health and Nutrition Examination Survey 1999–2000 cohort (2,3) and a large western U.S. study (4) are consistent in finding that ∼34% of type 2 diabetic patients on medication are using insulin. However, a more recent study (5) in the Canadian primary care setting reported only a 14% use of insulin, while two independent Australian studies (6,7) and our own results show an insulin prevalence of 16–18%. Studies in Denmark (8) and France (9) establish an insulin prescription rate of 24 and 17%, respectively. It therefore appears that physicians in U.S. are more likely to initiate insulin therapy for type 2 diabetic patients than their colleagues in other Western countries. The discrepancy between physicians’ attitudes, as reported by Peyrot et al. (1), and actual practice may represent a lack of generalizability of their findings or that the such “attitudes” are not the principal determinants of prescribing behavior.

1
Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, Landgraf R, Kleinebreil L, the International Dawn Advisory Panel: Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study.
Diabetes Care
28
:
2673
–2269,
2005
2
Koro CE, Bowlin SJ, Bourgeois N, Fedder DO: Glycemic control from 1988 to 2000 among U.S. adults diagnosed with type 2 diabetes: a preliminary report.
Diabetes Care
27
:
17
–20,
2004
3
Saydah SH, Fradkin J, Cowie CC: Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes.
JAMA
291
:
335
–422,
2004
4
Harmel AP, Ryan D, Thompson R: Glycohemoglobin assessment program: glycated hemoglobin and epidemiologic variables in patients with type 2 diabetes.
Endocr Pract
8
:
184
–190,
2002
5
Harris SB, Ekoe JM, Zdanowicz Y, Webster-Bogaert S: Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study).
Diabetes Res Clin Pract
70
:
90
–97,
2005
6
Clifford RM, Davis WA, Cull CA, Bruce DG, Batty KT, Davis TM: Greater use of insulin by southern European compared with Anglo-Celt patients with type 2 diabetes: the Fremantle Diabetes Study.
Eur J Endocrinol
151
:
579
–586,
2004
7
Kemp TM, Barr EL, Zimmet PZ, Cameron AJ, Welborn TA, Colagiuri S, Phillips P, Shaw JE: Glucose, lipid, and blood pressure control in Australian adults with type 2 diabetes: the 1999–2000 AusDiab.
Diabetes Care
28
:
1490
–1492,
2005
8
Kristensen JK, Bro F, Sandbaek A, Dahler-Eriksen K, Lassen JF, Lauritzen T: HbAlc in an unselected population of 4438 people with type 2 diabetes in a Danish county.
Scand J Prim Health Care
19
:
241
–246,
2001
9
Detournay B, Raccah D, Cadilhac M, Eschwege E: Epidemiology and costs of diabetes treated with insulin in France.
Diabetes Metab
31
:
3
–18,
2005

P.J.P. has been on an advisory board for and has received honoraria from Novo Nordisk and Aventis.