Motivational Interviewing to Improve Insulin Acceptance in Insulin-Naïve Korean Patients with Type 2 Diabetes

Abstract

Despite the well documented effectiveness of insulin on glycemic control, many patients with type 2 diabetes are reluctant to receive insulin therapy, called Psychological Insulin Resistance (PIR). Motivational Interviewing (MI) is a client-centered counseling method that may improve PIR and insulin acceptance behavior. The purpose of the study was to examine the effect of MI on insulin acceptance in insulin naïve patients with type 2 diabetes. Participants were recruited from outpatient clinics in two academic affiliated hospitals in South Korea. A matched subjects design was used to allocate the intervention (n=55) and control (n=55) groups based on age, gender, and the stage of intention to receive insulin therapy. The stages of intention to receive insulin therapy were pre-contemplation, contemplation, and action stages. Sociodemographic and clinical factors (years of diabetes diagnosis, medications, HbA1c, comorbidity) were collected by chart reviews. Six MI sessions (2 face-to-face [60 min/session] + 4 telephone sessions [20 min/session]) were provided to the intervention group by 6 trained nurses for 3 months. The effect of MI was measured by attitudes toward diabetes, PIR, and intention to receive insulin therapy at baseline and at 3 months using validated measures. Data were analyzed with paired t-test, t-test, and χ²-test. There was no significant difference in clinical factors, attitudes toward diabetes, PIR, and intention to receive insulin therapy between intervention and control groups at baseline. After the 6 MI sessions, the intervention group improved the intention to receive insulin therapy (χ²=10.44, p=.01) and attitudes toward diabetes (t=2.60, p<.01), and <significantly decreased PIR (t=-2.71, p<.01). MI combined with face-to-face and telephone sessions may be an effective strategy to improve attitudes toward diabetes, PIR, and intention to receive insulin therapy in insulin naïve Korean patients with type 2 diabetes. Disclosure Y. Song: None. J. Cho: None. H. Lee: None. K. Park: None. Y. Lee: None. B. Kim: None. K. Seo: None. A. Lim: None. Y. Jun: None. S. Nam: None.