Injectable treatments, such as
glucagon-like peptide-1 receptor agonists and
insulin, are options for the pharmacologic treatment of
type 2 diabetes. Numerous barriers lead to delay in initiating
injectable treatment, which, in turn, may lead to inadequate
glycemic control and increased risk of
diabetes-related complications, underscoring the need to understand and address these barriers. Barriers to the initiation of
injectable therapy, strategies to mitigate barriers, and information about needle attributes and their relation to needle
pain are reviewed on the basis of published literature retrieval and our clinical experience. Barriers to the initiation of
injectable therapy originate from both patients and practitioners. Anxiety about and fear of injection-associated
pain has been estimated to affect approximately 30%-50% of patients before the initiation of diabetes education interventions. Advances in needle design have minimized the
pain associated with
injections, and recent data suggest that actual
pain and
bleeding associated with various needle gauges (21-gauge to 31-gauge) are mild. Other barriers include concerns about the ability to handle
injectable therapy, concerns about treatment side effects, and impacts on quality of life. Practitioners can help to mitigate barriers to
injectable treatment for
type 2 diabetes by understanding patient perceptions, improving education, and setting realistic expectations about
therapy. Strategies for minimizing injection-associated fear and anxiety include a combination of assessment, appropriate needle selection, patient education, behavioral interventions, and monitoring.