Overcoming psychological barriers in insulin therapy

Abstract

Background: Research shows that tight glycemic control is a major factor in forestalling the microvascular and macrovascular complications that accompany diabetes mellitus (DM). Recent evidence shows that earlier use of insulin therapy is beneficial for people who are at higher risk for these complications because it provides more effective glycemic control. Yet, some patients either do not adhere to their insulin therapy or they modify their regimens in an unprescribed way. Objective: The goal of this article was to examine the psychological barriers some patients with DM have to insulin therapy. Also discussed are strategies to overcome these barriers. Methods: A literature search of MEDLINE was conducted for the period 1992 through 2005, using search word combinations including psychological barriers in people with diabetes, insulin therapy, needle phobia, injection anxiety, weight gain, and fear of hypoglycemia. Relevant articles relating to the topic of overcoming psychological barriers in insulin therapy were studied and summarized. Results: The primary reasons why some patients alter their insulin intake are injection-related anxiety, concern about weight gain, and fear of hypoglycemia. Injection-related anxiety, or needle phobia, is associated with higher levels of anxiety, depression, and phobic symptoms; it can result in poor glycemic control. Such patients should be identified early in therapy so that attention can be directed to address this anxiety. Weight gain can become a circuitous problem; the patient may be overweight at the time of DM diagnosis and then fear a weight gain after the initiation of insulin therapy. This may lead to a patient's decision to skip doses of insulin therapy and sacrifice glycemic control in the process. Fear of hypoglycemia can be avoided through awareness of the causes of low blood glucose and prescribing newer insulin analogues that have lesser serum peaks and troughs over a 24-hour period. Conclusions: Good communication between patient and clinician is the key in overcoming any psychological barriers to insulin therapy that some patients may have. The optimal use of insulin therapy is dependent on the patient's intentions to use it as prescribed.