Insulin Treatment Appraisal Scale Research Articles

Tests employed in the psychometric validation of the Insulin Treatment Appraisal Scale (ITAS) in T2DM patients; a systematic review of the literature

BackgroundPsychological Insulin Resistance (PIR) and negative perceptions regarding insulin treatment are noteworthy challenges in T2DM management, which hinder the timely initiation of insulin treatment. To get past these obstacles a reliable tool is required to evaluate patients’ perspectives on insulin administration. Our study aims to conduct a comprehensive systematic review to evaluate the validity and reliability of different validation tests used in the psychometric validation of the ITAS in T2DM patients.MethodsA literature search was carried out, using PubMed, Google Scholar, EMBASE, Cochrane Library and Science Direct. Only those studies assessing content validity, construct validity, concurrent validity, discriminant validity, internal consistency reliability (Cronbach’ α), and items-total correlation were retrieved.ResultsA total of 14 studies illustrated the validity and reliability of ITAS in T2DM patients. Content validity results of S-CVI was 0.97, and I-CVI was 0.8–1.00. Construct validity with factor loading was greater than the threshold value of 0.3. The concurrent validity of ITAS vs. PAID, WHO-5, and SPI was 0.35 (P < 0.05), −0.14 (P < 0.05), and 0.80 (P < 0.001) respectively. The mean difference between insulin and non-insulin group was significant (P < 0.001) showing reliable discriminant validity. Reported results of Cronbach’s α for the main scale (0.79–0.89), subscale-1 (0.72–0.9), and subscale-2 (0.61–0.89) showed “good to excellent” internal consistency reliability of ITAS. Item-total correlation results for the main scale, subscale-1, and subscale-2 were (0.40–0.82), (0.31–0.74) and (0.34–0.58) respectively. Test-retest reliability of ITAS was 0.571–0.87.ConclusionsStudy findings confirm the robustness of various validation tests utilized in the psychometric validation of ITAS in T2DM patients. ITAS is a well-validated and reliable tool for determining the perspectives, PIR, and changes in patients’ perception over time and it can be used to overcome hurdles in the timely initiation of insulin treatment in T2DM patients.

Investigation of the relationship between the attitudes of patients with type 2 diabetes toward insulin therapy and complementary alternative medicine

AimThis study aimed to determine the attitudes of patients with type 2 diabetes toward insulin treatment and complementary alternative medicine and to examine the relationship between them. MethodA cross-sectional design was used in the study. A total of 293 patients with type 2 diabetes were included in the study. The study data were collected by using a Descriptive Information Form, Complementary, Alternative and Conventional Medicine Attitude Scale (CACMAS), and the Insulin Treatment Appraisal Scale (ITAS). The factors related to the attitudes of patients with type 2 diabetes toward insulin were examined by using multiple linear regression analysis. ResultsIt was determined that 36.5% of the patients used CAM, 49.8% received insulin therapy, and that 38.6% received oral antidiabetic treatment. Patients' mean score on the total CACMAS was 106.8 ± 19.7, indicating a moderately positive attitude. Their mean score on the total ITAS was 57.1 ± 11.6, suggesting that they had a negative attitude toward insulin therapy. In regular drug use, negative attitudes toward insulin decreased (β = −0.151, p < 0.001), and when dissatisfaction with conventional medicine increased, negative attitudes toward insulin increased, as well (β = −0.432p<0.05). ConclusionWhile almost all of the patients (93.9%) had a negative attitude toward insulin, they had a moderately positive attitude toward the use of CAM. A significant portion of them (36.5%) stated that they used CAM. There was a weak positive correlation between attitude toward CAM and negative attitude toward insulin. KeywordsInsulin, attitude, type 2 diabetes, complementary alternative medicine

Risk perceptions of patients with type 2 diabetes mellitus regarding insulin therapy and diabetes complications: Across-sectional study.

This study was conducted to determine the risk perceptions of patients with type 2 diabetes mellitus (T2DM) regarding insulin therapy and diabetes complications. Self-care behaviour is an important requirement for managing T2DM, and risk perceptions are thought to play a key role in this behavioural process. It is predicted that an accurate risk perception will contribute to diabetes management and the reduction in diabetes-related complications. This study was conducted as cross-sectional and a descriptive study. The STROBE checklist was used. The study was conducted with 330 patients with T2DM who presented to the endocrinology outpatient clinic of the Eskisehir City Hospital between October 2020 and May 2021. A personal information form, the Insulin Treatment Appraisal Scale and the Risk Perception Survey-Diabetes Mellitus were used to collect data. The SAS 9.4 software package was used for the statistical analysis. Data were evaluated using descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test and the Spearman correlation analysis. It was determined that 62.4% of the patients with T2DM participating in the study were female, the mean age was 56.7 ± 9.1 years, 50.6% were primary school graduates, 31% used oral antidiabetic medications, and 58.7% used insulin together with oral antidiabetic drugs. The mean score of participants on the total Insulin Treatment Appraisal Scale was 75.1 ± 11.5, and the level of negative perceptions towards insulin use was found to be high. The participants' mean score on the total Risk Perception Survey-Diabetes Mellitus was 3.9 ± 0.8, and it was found that they had high levels of risk perceptions of diabetes complications. There was a moderate, statistically significant negative correlation between the Insulin Treatment Appraisal Scale and the Risk Perception Survey-Diabetes Mellitus. Patients with perceptions of a lower risk for diabetes complications had more negative attitudes towards insulin therapy. It is recommended to determine the risk perceptions of patients with T2DM and to plan appropriate nursing interventions that can increase their positive perceptions and change their negative perceptions so that they can make healthy behaviour changes. Additionally, it is recommended that patients with T2DM should be supported and the number of studies in this field should be increased. The effective management of diabetes requires cooperation between patients with T2DM and health professionals. Nurses should perform a constant evaluation and follow-up to address patients' knowledge, perception and actual health behaviours and to guide a culturally and gender-sensitive care plan. For individualised care plans that provide appropriate support and counselling, it is necessary to constantly assess risk factors and barriers to preventive health behaviours and perceptions. Patients with T2DM contributed their data to the study.

Patient perception towards shifting oral antihyperglycemic agents to injectable insulin and associated factors in the diabetes clinic of Tikur Anbessa specialized hospital: Cross-sectional study

BackgroundWith the growing understanding of the importance of preserving adequate glycemic control for the prevention of long-term diabetes-related complications, insulin therapy has become increasingly recommended for type 2 diabetes. However, insulin use in various healthcare settings remains low due to patients' low levels of acceptability of insulin therapy, which necessitates evaluating patients' attitudes. ObjectiveTo assess patients' perception toward shifting oral antihyperglycemic agents to insulin and associated factors at the ambulatory diabetes clinics of Tikur Anbessa Specialized Hospital (TASH). MethodA cross-sectional study design was applied using a pre-tested interviewer-administered questionnaire on adult type 2 diabetes patients on follow-up at the diabetes clinic of TASH, Ethiopia from July to September 2021. The questionnaire tool was adapted from Insulin Treatment Appraisal Scale with modifications to fit the purpose of the study. Data was gathered, cleaned up, entered, and analyzed using Statistical Package for the Social Sciences (SPSS) version 23 for descriptive and logistic regression. For logistic regression data, a p-value of 0.05 was used to determine the statistical significance. ResultOf 293 patients, 65.9% were female. Study participants had a mean age of 53.9 ± 10.9 years. About 45% and 75% of the participants have complications and comorbidities, respectively with a mean disease duration of 19.16 ± 8.2 years. Almost 54% of patients on oral antihyperglycemic agents were unwilling to start insulin. A perception score below the median was observed in 56.3% of the respondents. Patients with primary and secondary education were 45% and 42% less likely to have a poor perception of shifting oral antihyperglycemic agents to insulin than those who couldn't read or write (P < 0.05), respectively. The study found that participants who were taking only oral antihyperglycemic agents had a 2.76 times poor perception than those who are on insulin treatment (P < 0.001). ConclusionPoor perception toward shifting oral antihyperglycemic agents to insulin was found to be high among study participants. It was substantially correlated with low educational attainment, financial constraints, exclusively using oral antihyperglycemic agents, duration of disease, and absence of disease complications.

Validation and application of the Insulin Treatment Appraisal Scale in Cuban patients with type 2 diabetes mellitus

IntroductionThe purpose of this study was to validate the Insulin Treatment Appraisal Scale (ITAS) in the Cuban population with type 2 diabetes mellitus. Material and methodsA cross-sectional, multicentre analytical study was performed in Cuba from February 2020 to April 2021; 199 patients were surveyed in a hospital institution and in primary healthcare. We used the Insulin Treatment Appraisal Scale, consisting of 20 items, with a minimum score of 20 points and a maximum of 100, where the higher the score, the worse the perception of insulin therapy. The validity of the instrument was determined by means of an exploratory factor analysis. The internal consistency and reliability of the scale were calculated by means of Cronbach’s alpha coefficient. A K-means cluster analysis was performed to establish a cut-off point for poor perception of insulin therapy. ResultsThe exploratory factor analysis supported the validity of the instrument, with a Cronbach's alpha of 0.747. There were statistically significant differences between patients under insulin and non-insulin treatment in terms of the answers given in all items of the scale. The total mean score obtained was 51.96 ± 10.78, and it was lower in insulin users compared to those who used other drugs (49.79 ± 10.07 vs 55.09 ± 11.12). A score ≥65 was proposed as a cut-off point for poor perception of insulin therapy. A positive relationship was found between the body mass index values and the total score of the scale. Being female and current treatment not involving insulin were factors associated with low perception of insulin therapy. ConclusionsThe instrument proved to be valid for the population in which it was applied. Insulin users turned out to be the ones with the best perception about its use. A cut-off point of ≥65 points for poor perception of insulin treatment was proposed for evaluation and comparison in future studies in other patient populations.

Evaluation of the effect of training given according to Pender's Health Promotion Model on psychological insulin resistance

This study was conducted to evaluate the effect of training given to individuals with Type 2 Diabetes Mellitus (Type 2 DM) according to Pender's Health Promotion Model on attitudes towards insulin treatment. A randomized controlled design was conducted with a pretest-posttest control group in the endocrinology outpatient clinic of a university hospital in Northern Cyprus with 68 individuals with Type 2 DM who started insulin treatment. The training content was prepared according to Pender's Health Promotion Model and the suitability of the training was ensured by obtaining expert opinions as necessary. Within the scope of the study, individuals were randomly assigned to intervention (n = 34) and control (n = 34) groups. The experimental group received three sessions of training and was followed up for three months. A Patient Enquiry Form and the Insulin Treatment Appraisal Scale were used. An informed consent form was obtained from the patients and all data were collected by the researcher using the face-to-face interview method. To conduct the research, the necessary institutional permission and ethics committee approval were obtained and ethical principles were followed. This study, in which education was given according toPender's Health Promotion Model was evaluated, found that there was no significant difference between the groups in terms of the sociodemographic characteristics and the disease and insulin treatment characteristics of the experimental and control groups (p > 0.05), and both groups were found to be homogenous. The training given according toPender's Health Promotion Model led to a significant improvement in some metabolic control variables and attitudes towards insulin treatment in the experimental group during the three months (p > 0.05). The education provided according to Pender's Health Promotion model helped patients develop a positive attitude towards insulin treatment and it is thus an applicable and reliable resource.

Assessing barriers to insulin therapy among people with type 2 diabetes in South Africa using the Insulin Treatment Appraisal Scale: A cross-sectional survey

AimsTo assess barriers to insulin therapy among people with type 2 diabetes after adapting the Insulin Treatment Appraisal Scale (ITAS) to the South African context. MethodsA panel of experts reviewed the original ITAS for clarity and relevance to the South African context. The ITAS was administered to 253 adults with type 2 diabetes attending diabetes outpatient clinics in the Tshwane Metropolitan Municipality. Internal consistency (Cronbach's alpha) was tested and construct validity was examined using exploratory factor analysis (EFA). PIR was appraised in insulin users and non-users. ResultsThe EFA revealed that the adapted ITAS had a two-factor structure, similar to the original scale, with acceptable internal consistency (α = 0.85). Insulin-using participants had significantly less negative attitudes to insulin therapy than non-users (40.7 ± 7.1 vs. 51.5 ± 11.2, p < 0.001). Compared to participants who used insulin, participants who did not use insulin were afraid of injecting themselves with a needle (71% vs. 11%, p < 0.001) and saw insulin treatment as a sign of worsening diabetes (63% vs. 29%, p < 0.001). ConclusionsConsistent with previous studies, participants who were not using insulin had more negative beliefs and attitudes towards insulin treatment than those who were already using insulin. South African clinicians should use the ITAS to assess positive and negative perceptions regarding insulin therapy in both insulin-naïve and insulin-treated people, to evaluate interventions to reduce PIR and improve treatment outcomes.

YOĞUN BAKIMA YATAN TİP 2 DİYABETLİ HASTALARIN İNSÜLİNE KARŞI ALGILARI İLE DİYABET ÖZ YÖNETİMLERİ ARASINDAKİ İLİŞKİNİN İNCELENMESİ

Aim: This study aimed to determine the level of perception of insulin and diabetes symptom management of patients with Type 2 diabetes who received inpatient treatment in intensive care. &#x0D; Materials and Methods: This study was conducted in the Internal Medicine and Anesthesia Intensive Care units of a state hospital during the period of December 01, 2020 and March 31, 2021. The sample of the study was composed of 100 voluntary patients who used insulin. Research data were collected via the Patient Introduction Form, Diabetes Self-Management Questionnaire and the Insulin Treatment Appraisal Scale. Written permission was obtained from ethics committee and patients. &#x0D; Results: The average age of the patients was 44.57 ± 14.8, 52% were female, 72% were single, 47% were primary school graduates, and 52% had a chronic complication related to diabetes. The mean time duration for being diagnosed with diabetes was 20.59 ± 12.87 years (3-52) while the mean duration of insulin use was 2.8 ± 1.17 years. Patients’ ITAS positive and negative item subscale mean scores were 11.44 ± 3.43 and 48.18 ± 12.09, respectively. Patients’ mean Diabetes Self-Management Questionnaire total score was 4.07 ± 1.74 (range: 0.62-8.75).&#x0D; Conclusion: Patients have a high negative perception towards insulin use and their diabetes self-management is below the average. There was a high level of negative correlation between patients’ negative insulin perception and glucose management and diet control sub-dimensions of their diabetes self-management.

Validación y aplicación de la escala de percepción del tratamiento con insulina en pacientes cubanos con diabetes mellitus tipo 2

IntroductionThe purpose of this study was to validate the Insulin Treatment Appraisal Scale in the Cuban population with type 2 diabetes mellitus. Material and methodsA cross-sectional, multicentre analytical study was performed in Cuba from February 2020 to April 2021; 199 patients were surveyed in a hospital institution and in primary healthcare. We used the Insulin Treatment Appraisal Scale, consisting of 20 items, with a minimum score of 20 points and a maximum of 100, where the higher the score, the worse the perception of insulin therapy. The validity of the instrument was determined by means of an exploratory factor analysis. The internal consistency and reliability of the scale were calculated by means of Cronbach's alpha coefficient. A K-means cluster analysis was performed to establish a cut-off point for poor perception of insulin therapy. ResultsThe exploratory factor analysis supported the validity of the instrument, with a Cronbach's alpha of 0.747. There were statistically significant differences between patients under insulin and non-insulin treatment in terms of the answers given in all items of the scale. The total mean score obtained was 51.96±10.78, and it was lower in insulin users compared to those who used other drugs (49.79±10.07 vs. 55.09±11.12). A score≥65 was proposed as a cut-off point for poor perception of insulin therapy. A positive relationship was found between the body mass index values and the total score of the scale. Being female and current treatment not involving insulin were factors associated with low perception of insulin therapy. ConclusionsThe instrument proved to be valid for the population in which it was applied. Insulin users turned out to be the ones with the best perception about its use. A cut-off point of≥65 points for poor perception of insulin treatment was proposed for evaluation and comparison in future studies in other patient populations.

'Is insulin right for me?': Feasibility of a pilot randomised controlled trial and acceptability of a web-based intervention to reduce psychological barriers to insulin therapy among adults with type 2 diabetes.

Acceptable and accessible interventions are needed to address 'psychological insulin resistance', which is a common barrier to insulin uptake among adults with type 2 diabetes (T2D). Our aim was to test the feasibility of a randomised controlled trial (RCT) study design and acceptability of a theoretically grounded, psycho-educational, web-based resource to reduce negative insulin appraisals among adults with T2D. A double-blinded, parallel group, two-arm pilot RCT (1:1), comparing intervention with active control (existing online information about insulin). Eligible participants were Australian adults with T2D, taking oral diabetes medications. prior use of injectable medicines; being 'very willing' to commence insulin. Primary outcomes: study feasibility (recruitment ease, protocol fulfilment, attrition, data completeness); secondary outcomes: intervention acceptability (intervention engagement, user feedback) and likely efficacy (negative Insulin Treatment Appraisal Scale [ITAS] scores at follow-up). Online surveys completed at baseline and 2weeks. During 4-week recruitment, 76 people expressed interest: 51 eligible and 35 enrolled (intervention=17, control=18; median[interquartile range] age=62[53, 69]years; 17 women). Protocol fulfilment achieved by 26 (74%) participants (n=13 per arm), with low participant attrition (n=6, 17%). Intervention acceptability was high (>80% endorsement, except format preference=60%). ITAS negative scores differed between-groups at follow-up (M diff=-6.5, 95% confidence interval: -10.7 to -2.4), favouring the intervention. This novel web-based resource ("Is insulin right for me?") is acceptable and associated with a likely reduction in negative insulin appraisals, relative to existing resources. This pilot shows the study design is feasible and supports conduct of a fully powered RCT.

Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review.

BackgroundThe management of diabetes is complex. There is growing recognition of the use of patient-reported outcome measures (PROMs) as a standardized method of obtaining an outlook on patients’ functional status and well-being. However, no systematic reviews have summarized the studies that investigate the measurement properties of diabetes PROMs.ObjectiveOur aims were to conduct a systematic review of studies investigating the measurement properties of diabetes PROMs by evaluating the methodological quality and overall level of evidence of these PROMs and to categorize them based on the outcome measures assessed.MethodsThis study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the Embase, PubMed, and PsychINFO databases. The PROMs were evaluated with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines.ResultsA total of 363 articles evaluating the measurement properties of PROMs for diabetes in the adult population were identified, of which 238 unique PROMs from 248 studies reported in 209 articles were validated in the type 2 diabetes population. PROMs with at least a moderate level of evidence for ≥5 of 9 measurement properties include the Chinese version of the Personal Diabetes Questionnaire (C-PDQ), Diabetes Self-Management Instrument Short Form (DSMI-20), and Insulin Treatment Appraisal Scale in Hong Kong primary care patients (C-ITAS-HK), of which the C-PDQ has a “sufficient (+)” rating for >4 measurement properties. A total of 43 PROMs meet the COSMIN guidelines for recommendation for use.ConclusionsThis study identified and synthesized evidence for the measurement properties of 238 unique PROMs for patients with type 2 diabetes and categorized the PROMs according to their outcome measures. These findings may assist clinicians and researchers in selecting appropriate high-quality PROMs for clinical practice and research.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020180978; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180978.

Impact of pharmacist insulin injection re-education on glycemic control among type II diabetic patients in primary health clinics

BackgroundInsulin injection technique re-education and diabetes knowledge empowerment has led to improved glycemic control. ObjectivesTo evaluate the impact of pharmacist’s monthly re-education on insulin injection technique (IT), lipohypertrophy, patients’ perception on insulin therapy and its effect on glycaemic control. MethodsThis randomized controlled, multi-centered study was conducted among type 2 diabetics from 15 government healthclinics. 160 diabetics with baseline HbA1C ≥ 8% and unsatisfactory IT technique were randomized into control or intervention group. Control group received standard pharmacist counselling during initiation and at 4th month. Intervention group received monthly counselling and IT re-education for 4 months. Assessment of diabetes, IT knowledge, adherence and perception towards diabetes were conducted using validated study tools Insulin Treatment Appraisal Scale (ITAS) and Medication Compliance Questionnaire (MCQ)). Results139 patients completed the study; control group (69), intervention group (70). In control group, all outcomes shown improvement except for patient’s perception. Mean HbA1C decreased 0.79% ± 0.24 (p = 0.001). In intervention group, all outcomes improved significantly. HbA1c reduces significantly by 1.19% ± 0.10 (p < 0.001). Monthly re-education improved patient’s perception towards insulin therapy (ITAS score reduced 1.44 ± 2.36; p = 0.021). Between groups, interventional arm shown significantly better improvement in all outcomes. Improvement was shown in IT technique (+2.02 score; p < 0.001), medication adherence (+1.48 score; p < 0.001) and ITAS (−1.99 score; p = 0.037). Mean HbA1C reduced an additional of 0.63% (p = 0.008) compared to control arm. ConclusionRe-education is more effective in increasing adherence, reducing lipohypertrophy, improving injection technique and patient’s perception on insulin therapy, thereby providing better glycaemic control.

Self-care, A1C and stigmatization as predictors of a negative perception of insulin among adults with type 2 diabetes: a hospital-based study in Turkey

PurposeThe purpose of this study was to investigate diabetes self-care behaviors, stigmatization and A1C as predictors of a negative perception of insulin treatment in insulin-treated type 2 diabetic patients.Design/methodology/approachA descriptive cross-sectional and relational design was used. The study was carried out in the Diabetes Training Centre and Endocrine and Metabolism Clinic of a university hospital in the southeast of Turkey between May and October 2017. The research sample consisted of 100 type 2 diabetic patients determined by using a convenience sampling method. An introductory information form for type 2 diabetic patients, the Insulin Treatment Appraisal Scale (ITAS), Diabetes Self-Care Activities Survey (DSCAS) and Barriers to Insulin Treatment Scale (BIT) were used to collect the research data. The data were analyzed using descriptive statistics, correlations and step wise multi-linear regression.FindingsThe number of daily insulin injections, training received about insulin and stigmatization was significant predictors of a negative perception of insulin treatment.Originality/valueStrategies to decrease diabetic individuals' fear of stigmatization should be utilized to minimize their negative insulin treatment perception (giving diabetic individuals training about diabetes, planning public training to inform society and using mass media tools). Diabetes educators should know that diabetic individuals' perception of the severity of the illness could influence the daily number of injections applied and decrease the negative perception regarding insulin.

Barriers to initiation of insulin therapy in poorly controlled type 2 diabetes based on self-determination theory.

Proper glycaemic control can slow progression of diabetes complications. One of the main causes of poor glycaemic control is delayed initiation of insulin therapy. To explain the reasons for delayed insulin initiation based on a behavioural model using patients' innate psychological needs. We enrolled 151 patients with type 2 diabetes who had indications for insulin therapy. Thirty general practitioners (GPs) were included as care providers. Patients were studied by questionnaires evaluating components of self determination theory, such as competency, relatedness and autonomy. We also evaluated patients' attitudes towards insulin therapy using the Insulin Treatment Appraisal Scale questionnaire. GPs' attitudes towards insulin therapy were assessed with a different questionnaire. Competency of patients was scored as acceptable (14.44/20). Relatedness score was low at around 15.63/30. The findings suggested that the patients' intrinsic motivation was less than their extrinsic motivation (8.41/15 vs 15.03/20). The main barrier to insulin therapy on the patients' side was rejection of severity of illness (67.5%). According to GPs, low compliance (96.7%) was the main cause of delayed insulin prescription. We observed that patients do not have a proper understanding about their illness. Due to the low score of relatedness as a representative of patients and care providers' relationship, we highlight the importance of educating both about insulin therapy and how they can have the most effective relationship in this process.

Psychometric Analysis Regarding the Barriers to Providing Effective Insulin Treatment in Type 2 Diabetic Patients.

IntroductionA psychometric analysis on type 2 diabetic (T2D) patients was performed to assess whether glycated hemoglobin (HbA1c) levels were dependent upon either the psychologic or economic attitude toward the use of insulin as a treatment for their diabetic condition.MethodsA cross-sectional study was designed using 271 patients with T2D who regularly visited a tertiary referral hospital in South Korea from June 2019 to December 2019. Each patient enrolled in this protocol was treated with insulin for at least 6 months, had recordings of their plasma HbA1c measurement, and completed validated questionnaires consisting of items focusing on patient attitudes toward insulin use [Insulin Treatment Appraisal Scale (ITAS)] and cost-related issues related to diabetic supply purchase. Multiple regression analyses were performed to determine the association between their HbA1c and each item on the questionnaires.ResultsIn both males and females, there was a significant association (P < 0.05) between HbA1c levels and multiple items on the ITAS questionnaire, which are generally regarded as a negative perception (ITAS 1 “personal failure” and ITAS 2 “illness severity” in males and ITAS 12 “expected harm” and ITAS 15 “restrictiveness” in females). In females, however, not all perceptions were negative, since one item (ITAS 8 “anticipated effect”) was correlated with the measurement of a lower HbA1c level (− 0.495 ± 0.211, P < 0.05). There was no association between the levels of HbA1c and the cost of insulin or associated diabetic supplies. Since only a few patients in this study chose to reduce their drug dosing because of cost, the resistance to using insulin is likely not driven by economic reasons.ConclusionThe psychometric results of the ITAS suggested that HbA1c levels were directly associated with a positive attitude of the patient to willingly use insulin for therapy. The cost of the insulin therapy was not associated with HbA1c levels. These findings in the Korean population suggest that continued education is needed to ensure that T2D patients have a reinforced positive psychology toward the use of insulin in the control of their glycemia.

Validation of the Chinese version of the insulin treatment appraisal scale

AimsTo test the reliability and validity of the Chinese version of the Insulin Treatment Appraisal Scale (ITAS) questionnaire in patients with type 2 diabetes mellitus (T2DM). MethodsA total of 200 patients with T2DM were consecutively recruited from the outpatient clinic in Taiwan. The World Health Organization guideline was followed to translate the questionnaire. The internal consistency was assessed by Cronbach’s α coefficient and item-total correlations. The construct validity was evaluated by using confirmatory factor analysis, convergent validity, and discriminate validity. ResultsThe Cronbach’s α coefficient for estimates of internal consistency of the total scale was 0.72, and ranged from 0.76 to 0.77 for the subscales. A value of ≥0.40 was considered being substantial. The item-total correlation values were 14 out of 20 items having substantial correlations (4 out of 4 items on the positive appraisal scale and 10 out of 16 items on the negative appraisal scale). The confirmatory factor analysis confirmed both positive and negative factors with total explained variance 33.9% (12.2% for positive subscale and 21.7% for negative subscale). The success rate, calculated from the item-total correlation values, was 70% for the convergent validity (100% for positive subscale and 63% for negative subscale) and 90% for discriminate validity (100% for positive subscale and 88% for negative subscale), respectively. Both the ceiling effect and floor effect were 0%. ConclusionsThe Chinese version of the ITAS questionnaire is a valid and reliable instrument for measuring the perceptions of insulin injection in patients with T2DM.

645-P: Diabetes Pueblo: A Community Health Worker–Led Educational Intervention for Latinos with T2D

In the U.S., Latinos have the highest proportion of type 2 diabetes (T2D) of any racial/ethnic group. Addressing cultural barriers and limited access to diabetes education may improve diabetes care and outcomes in this population. Diabetes Pueblo (DP) is an 11-week, culturally tailored, diabetes self-management education and support (DSMES) program led by Latinos in the community (Promotores). The program has two modules, diabetes fundamentals (DF) and insulin success. A pilot study was conducted to evaluate the feasibility of DP through class attendance and participant satisfaction. Additional endpoints included biometric data, HbA1c, the Diabetes Self-Management Questionnaire (DSMQ), and the Insulin Treatment Appraisal Scale (ITAS). Participants were 25 Latinos with T2D (20 completers) with a mean age of 55.8±10.5 years (64% female, 92% born in Latin America, 39% completed high school). Class attendance averaged 82%. Small nonsignificant improvements were observed in HbA1c, DSMQ, and ITAS positive appraisal at the completion of the program. ITAS negative appraisal scores improved significantly from 43 to 38 (p=0.02). Participant feedback reported improvement in distinguishing between diabetes and prediabetes (p=0.01). Post-class focus groups revealed very high satisfaction with the program, including improved understanding of how behaviors impact health and that insulin initiation does not indicate personal failure. There were no significant changes in biometrics possibly due to the short study duration. These results demonstrate the program’s feasibility through high attendance, program approval, improved diabetes self-management knowledge and acceptance of insulin therapy. This highlights the importance of using a culturally appropriate education program taught by community health workers for higher attendance and engagement. Future research may include larger-scale evaluations of the program with long-term follow-up to detect changes in biometric data. Disclosure J. Creason: None. C. Axelrod: None. M.M. Conneely: None. C. Landeros: None. M. Diaz-Rea: None. A.D. Xi: Employee; Self; Eli Lilly and Company. R. Paczkowski: Employee; Spouse/Partner; Amgen. Employee; Self; Eli Lilly and Company. B. Reed: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. F. Gelsey: Employee; Self; Lilly Diabetes. Stock/Shareholder; Self; Lilly Diabetes. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. Funding Eli Lilly and Company

Attitudes among Adults with Type 2 Diabetes Affecting Insulin Initiation and Discontinuation

Approximately 30% of patients with type 2 diabetes (T2D) are reluctant to initiate basal insulin when recommended by their healthcare provider (HCP). Even after initiation, many patients use insulin intermittently. Examining patients’ attitudes towards insulin and their links to subsequent use can aid HCPs in improving insulin uptake and adherence. 594 T2D adults across seven countries who indicated initial reluctance to begin basal insulin but eventually agreed to do so [mean age = 53.3 (SD=11.3), 56.7% male], participated in the EMOTION survey. In addition to self-reported insulin behavior (immediate initiation vs. delay, discontinued use for ≥7 days), attitudes towards insulin immediately prior to initiating insulin were captured using a modified version of the Insulin Treatment Appraisal Scale (mITAS). An exploratory factor analysis of the 21 negatively worded mITAS items (1=strongly disagree to 5=strongly agree) yielded four factors: “concerns about injections” (M=3.4, SD=1.0), “failed diabetes management” (M=3.8, SD=0.8), “increased disease severity” (M=3.0, SD=0.9), and “concerns about side effects” (i.e., weight gain, hypoglycemia) (M=3.4, SD=0.8). In models controlling for patient characteristics and clustering by country, higher scores (more negative appraisal) in all four mITAS factors were linked with greater likelihood of delaying insulin initiation (ORs: 1.34 to 1.73; all p &amp;lt;0.05). Only “concerns about side effects” was associated with discontinuation and inversely related (OR=0.60, p &amp;lt;0.05). Overall, higher mITAS scores were associated with being female, younger, more recently diagnosed, and without previous experience with injectable medications. Negative patient appraisals of insulin are linked with delays in their insulin initiation in T2D; while other factors may be more impactful for predicting discontinuation. These patient attitudes should be considered when discussing insulin initiation. Disclosure D.M. Hessler: Consultant; Self; Eli Lilly and Company. W. Polonsky: Consultant; Self; Abbott, AstraZeneca, Dexcom, Inc., Sanofi, Novo Nordisk Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Servier, Ascensia Diabetes Care, Merck &amp; Co., Inc., MannKind Corporation, Glooko, Inc., Roche Diabetes Care Health and Digital Solutions. L. Fisher: Consultant; Self; Eli Lilly and Company, Abbott, Merck &amp; Co., Inc.. F.J. Snoek: None. I. Hadjiyianni: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. D. Cao: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J.I. Ivanova: Other Relationship; Self; Eli Lilly and Company. Employee; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc. U. Desai: Other Relationship; Self; Eli Lilly and Company, AstraZeneca. M. Perez-Nieves: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.

Diabetes stigma is associated with negative treatment appraisals among adults with insulin-treated Type 2 diabetes: results from the second Diabetes MILES - Australia (MILES-2) survey.

To explore factors associated with negative insulin appraisals among adults with Type 2 diabetes, including perceived and experienced diabetes stigma. The second Diabetes MILES - Australia study (MILES-2) is a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 456 adults with insulin-treated Type 2 diabetes (38% women; mean ± sd age: 61.2 ± 8.8 years; diabetes duration: 14.5 ± 7.5 years; years using insulin: 6.4 ± 5.5). Participants completed validated measures of perceived and experienced diabetes stigma (Type 2 Diabetes Stigma Assessment Scale), insulin appraisals [Insulin Treatment Appraisal Scale (ITAS)] and known correlates of insulin appraisals: diabetes-specific distress (Problem Areas In Diabetes scale) and diabetes-specific self-efficacy (Confidence in Diabetes Self-care scale). A multiple linear regression was conducted (N = 279) to determine the contribution of those variables found to be associated with ITAS Negative scores. Univariable analyses revealed negative insulin appraisals were associated with demographic and self-care characteristics (age, employment status, BMI, years using insulin, injections per day), self-efficacy, diabetes-specific distress and diabetes stigma (all P < 0.01). Number of injections per day [regression coefficient [95% confidence interval]: 0.74 [0.08, 1.40]; P = 0.028], self-efficacy [-0.12 [-0.19, -0.06]; P < 0.001] and diabetes stigma [0.39 (0.31, 0.46); P < 0.001) significantly and independently contributed to the final multivariable model, explaining 58% of the variance in ITAS Negative scores. The independent contribution of diabetes-specific distress was suppressed following the inclusion of diabetes stigma. This study represents the first step in understanding the relationship between perceived and experienced diabetes stigma and negative insulin appraisals, and provides quantitative evidence for the strong, independent relationship between these two important constructs.

Peer Education Group Intervention to Reduce Psychological Insulin Resistance: A Pilot Mixed-Method Study in a Chinese Population.

IntroductionPsychological insulin resistance (PIR) is common among type II diabetes (DM) patients. Although interventions to reduce PIR have been suggested, there is no standardized intervention to reduce PIR. This trial aimed to assess the preliminary effectiveness of a well-structured interventional patient group (for sample size calculation for larger trials), as well as the acceptability and feasibility of this intervention group.MethodsThis study used a quasi-experimental, mixed-method approach. Fifty-three patients with DM were recruited to an interventional group that included a general education of DM and insulin, an insulin pen demonstration, and an insulin-using peer sharing session. Each group consisted of around 15 participants and lasted for 2 h each. The validated Chinese version of the insulin treatment appraisal scale (C-ITAS) was administered before, immediately after, and 1 month after the intervention to measure any changes in the participants’ PIR. Patients were interviewed to assess the acceptability of the intervention until data saturation.ResultsRepeated measures ANOVA showed that the post-intervention C-ITAS scores (immediately post group and at 1 month) were lower than the pre-intervention C-ITAS scores (p < 0.001). Changes in multiple attitudes toward insulin were detected before and after the group intervention. Ten patient interviews were conducted and found that the intervention was welcomed by all interviewees; no discomfort or adverse reactions were reported.ConclusionPreliminary results showed that patient intervention groups with general education, insulin pen demonstration, and peer sharing appeared to be safe, acceptable, and effective in reducing PIR. Larger multicenter trials are needed to generalize these findings.Electronic supplementary materialThe online version of this article (10.1007/s13300-017-0347-3) contains supplementary material, which is available to authorized users.