Psychological insulin resistance and its impact on self‐management in type II diabetes mellitus patients treated with insulin therapy

Abstract

AimsPsychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self‐management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self‐management in patients with type II diabetes mellitus treated with insulin therapy.MethodsWe adopted a cross‐sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self‐management using the barriers to insulin treatment questionnaire and the partners in health scale.ResultsA total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age.ConclusionInsulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self‐management.

The Barriers to Insulin Therapy Initiation in Type 2 Diabetes Patients: A Study of General Practitioner Perceptions in Huinan Community in South Shanghai

“… 20 From the perspective of the doctors, a patient’s reactions, such as their fear of receiving an injection, their misconceptions about insulin therapy (some patients thought insulin was addictive), and their difficulty with the complex insulin injection procedure, could render it difficult for them to receive proper treatment, enhancing the doctor’s unwillingness to begin administering insulin to them. 6 , 21 Insurance and expense were not concerned for the GP because the national health insurance program insured most patients. However, even after training, we found that a higher percentage of these barriers remained, indicating that they could not be quickly addressed by clinical training for skill (ie, the shortage of nurse follow-up) and that further work from society and the health insurance system was necessary in addition to GP training.…”

“… 4 , 5 Insulin therapy initiation is challenging for various parties, including the patient, the physician, the family, the social worker, and the nurse. 6 , 7 The patient’s fear of injections is a significant obstacle to using insulin in primary care. 8 Nevertheless, GPs were presented with additional challenges to insulin therapy.…”