Psychological Insulin Resistance Research Articles

Using Motivational Interviewing to Overcome Psychological Insulin Resistance

Psychological insulin resistance can delay insulin therapy when initiating insulin therapy in patients with type 2 diabetes mellitus. The role of diabetes educator is important in reducing patients’ psychological insulin resistance through various approach. Motivational interviewing not only promotes diabetes selfmanagement, but also can help to overcome psychological insulin resistance. Diabetes educators can help smooth the transition to insulin in diabetic patients using motivational interviewing. In this article, I introduce basic counseling skills of motivational interviewing addressing psychological insulin resistance.

Factors Influencing the Subjective Health Status of Men with Insulin-treated Type 2 Diabetes Mellitus: A Secondary Analysis Using Quantile Regression Analysis

Purpose: The aim of this study was to identify the factors associated with the subjective health status by level in men with type 2 diabetes mellitus (T2DM) receiving insulin treatments. Methods: This study was a secondary analysis. A total of 120 male outpatients with insulin-treated T2DM completed in a questionnaire from July to November 2019, and results were analyzed using multiple linear and quantile regression to determine factors related to subjective health status. The 10th, 25th, 50th, 75th, and 90th conditional quantiles were considered with the aim of identifying different factors that contributed to subjective health status. Results: Subjective health status was measured by the EuroQol visual analog scale, and its mean score was 61.29±19.00 points out of 100. Through ordinary least squares analysis, family support, knowledge, self-care, and psychological insulin resistance explained 57.2% of the variance in subjective health status. Through quantile regression analysis, family support and knowledge were identified as factors significantly related factors for all percentiles, and self-care and psychological insulin resistance were the significant factors for the 50th, 75th, and 90th percentiles. Conclusion: The results of this study highlight the importance of the subjective health status of men with T2DM receiving insulin treatment, especially healthcare professionals looking for more effective intervention methods. Strategies that take into consideration various factors that explain an individual’s subjective health status have the potential to improve patient health.

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

Psychological 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. We 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. A 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. Insulin 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.

Evaluation of an association between maternal prenatal psychological stress and insulin resistance during pregnancy and postpartum

Objectives: Various physiological mechanisms counteract insulin resistance (IR) during normal pregnancy. Psychological stress is a known, independent risk factor for developing IR. Pregnancy-specific psychological stress may cause IR and increase the risk of overt diabetes. Hence, the study aims to evaluate maternal psychological stress using multiple stress markers and their association with changes in IR during pregnancy and postpartum. Materials and Methods: Anthropometric measurements such as height, weight and skinfold thickness were measured using standard techniques. The stress markers were assessed using perceived stress scales (K10 questionnaire), a physiological marker of stress (Heart rate variability [HRV] measures) and biochemical stress markers (Saliva, hair cortisol levels). IR was estimated using homeostasis model assessment-estimated IR (HOMA-IR). The association of stress markers with IR was studied among fifty healthy pregnant women during pregnancy and postpartum. Results: The psychological stress scores and saliva cortisol were significantly higher during pregnancy than postpartum (P = 0.000). A comparison of cardiac autonomic function as assessed by HRV measures shows that high frequency in normalised units (HFnu) was significantly higher during the postnatal period than in the prenatal period (P = 0.000). High frequency (HF) spectral power in absolute units was also significantly higher (P = 0.002) in the postpartum period (2612.30 ± 432.24) when compared with the prenatal period (1446.10 ± 299.15). Low frequency in normalised units (LFnu), low frequency (LF)/HF ratio was significantly higher during the prenatal period than in the postnatal period (P = 0.000). As assessed by HOMA-IR values, IR was significantly higher during the prenatal period than postpartum (P = 0.04). There was a significant positive correlation between prenatal psychological stress scores, HRV parameters (LFnu, LF/HF) and postnatal IR. Conclusion: Pregnancy is associated with higher psychological stress levels and IR than postpartum. Furthermore, the maternal cardiac autonomic marker could predict postnatal IR among healthy pregnant women.

Using insulin to manage type 2 diabetes

Exogenous insulin injections are used in type 2 diabetes to complement non-insulin medication or as standalone therapy, alongside lifestyle changes. Therapeutic inertia by health professionals, as well as ‘psychological insulin resistance’ by individuals with diabetes, contribute to delays in insulin use. Nurses have a pivotal role in identifying individuals who require insulin therapy and to counsel and support them through person-centred insulin education. This article outlines the NICE recommendations for insulin therapy and factors contributing to delays in insulin initiation, as well as resources that can be signposted to individuals with type 2 diabetes.

Assessment of psychological insulin resistance in patients on insulin therapy

Assessment of psychological insulin resistance in patients on insulin therapy

Insulin hesitancy: A language-based model.

Psychological insulin resistance is a well known entity. This communication proposes the term 'insulin hesitancy' to describe the hesitation that a person living with diabetes experiences, when advised to take insulin. It approaches hesitancy through a triage model, based upon the language used by the patient. By identifying the predominant adverb, "will not", "shall not", or "cannot" in the patient's speech, the diabetes care professional can assess the degree of insulin hesitancy, and tailor his or her conversation towards overcoming it.

Assessment of Barriers toward Initiating Insulin among Gestational Diabetes Pregnant Women, Diabetes Center, Hera’a General Hospital, Makkah

Background: Gestational diabetes mellitus (GDM) is one of the most common pathologies in pregnancy. Unfortunately, both clinicians and patients are often reluctant to begin insulin therapy, a phenomenon that has been known as psychological insulin resistance (PIR). Objectives: To assess the barriers of initiating insulin among GDM pregnant women. Patients and Methods: An observational cross-sectional study was conducted in the GDM clinic, Diabetes Center in Hera’a General Hospital, Makkah, Saudi Arabia in a period of 4 months. A self-administered validated questionnaire was adopted. It included socio-demographic data of women, perceived (personal, social, pharmacological, occupational and misconception) barriers towards insulin therapy and possible solutions to overcome these barriers. Results: A total of 164 pregnant women with gestational diabetes were included in the study. The age of 36.4% of them exceeded 35 years. Among personal barriers, preferring other treatment methods over insulin (56.4%) and unaware of insulin dose control method (45.4%) were commonly reported. Regarding family barriers, 23.6% reported past family experience of insulin-related complications. Concerning side effects, fear of hypoglycemia (59.4%) and fear of weight gain (50.9%) were most frequently reported barriers against use of insulin. Regarding misconceptions about insulin injections, 26% believed that insulin is addictive; the injection will continue for life. Among work-related barriers, irregular eating times during working hours and long working hours (55.2%) were barriers for insulin use. Facilitating access to healthcare services (94%), engage the patient in decision-making and development of the treatment plan (91.6%), activate virtual clinics and social media for remote follow-up (86.6%) and organize social support groups for pregnant women who use insulin to share their experiences were the most frequently reported possible solutions to initiate and commit to insulin therapy. Conclusion: Various barriers were identified against initiation of insulin therapy in the management of gestational diabetes; mostly due to personal factors, misconception and work-related factors. Prompt actions are needed to overcome these barriers.

Psychological insulin resistance and affecting factors in patients with type 2 diabetes

Aim: The aim of this study was to investigate psychological insulin resistance and factors affecting it in patients with diabetes mellitus. Method: This descriptive study was conducted in a university hospital in eastern Turkey. The population of the study consisted of patients diagnosed with type 2 DM in the internal medicine clinic of the said hospital. Data were collected using the Patient Identification Form, Problematic Areas in Diabetes, Treatment Compliance and Psychological Insulin Resistance Scales in Patients with Diabetes, which were used to determine the descriptive characteristics of the patients. Findings: In the study, it was found that the mean score of the problematic areas in diabetes scale was 37.89 ± 5.81 and the patients did not experience emotional distress, the mean score of the treatment compliance scale was high (96.56 ± 13.28) and their compliance to treatment was low, the mean score of the psychological insulin resistance scale was 48.40 ± 8.79 and the psychological insulin value of the patients was high. Conclusion: As a result of the study, it was determined that patients’ BMI, education level, employment status, problematic areas in diabetes scale and treatment compliance scale scores were important predictors for psychological insulin resistance. Özet Amaç: Araştırma, diyabetli hastalarda psikolojik insülin direnci ve etkileyen faktörlerin incelenmesi amacıyla yapılmıştır. Metot: Tanımlayıcı tipteki bu araştırma, Türkiye’nin doğusunda yer alan bir üniversite hastanesinde yürütülmüştür. Araştırmanın evrenini adı geçen hastanenin dahiliye kliniğinde tip 2 DM tanısı almış hastalar oluşturmuştur. Araştırma verileri, hastaların tanıtıcı özelliklerini belirlemek amacıyla kullanılan Hasta Tanıtım Formu, Diyabette Problemli Alanlar, Tedaviye Uyum ve Diyabetli Hastalarda Psikolojik İnsülin Direnci Ölçekleri ile toplanmıştır. Bulgular: Araştırmada hastaların diyabette problemli alanlar ölçeği puan ortalamasının 37.89 ± 5.81 olduğu ve emosyonel distres yaşamadığı, tedavi uyum ölçeği puan ortalamasının yüksek olduğu (96.56 ± 13.28) ve tedaviye uyumlarının düşük olduğu, psikolojik insülin direnci ölçeği puan ortalamalarının 48.40 ± 8.79 olduğu ve hastaların psikolojik insülin değerinin yüksek olduğu bulunmuştur. Sonuç: Araştırmanın sonucunda hastaların BKİ, eğitim düzeyi, çalışma durumu, diyabette problemli alanlar ölçeği ve tedavi uyum ölçeği skorlarının psikolojik insülin direnci için önemli yordayıcılar olduğu belirlenmiştir.

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.

Key factors for overcoming psychological insulin resistance: A qualitative study in Japanese people with type 2 diabetes

AimsWe report the key factors that motivate reluctant Japanese people with type 2 diabetes (T2D) to initiate insulin treatment. MethodsParticipants were asked questions pertaining to 2 primary areas of exploration in a concurrent mixed methods approach: (a) understanding people’s thoughts and perceptions before and after insulin initiation and any related factors; and (b) exploring the reasons behind people’s responses. Data were analyzed using Steps for Coding and Theorization. ResultsParticipant responses broadly related to 3 themes which influence insulin initiation; 1. Advice from a health care provider (HCP) that insulin is an appropriate treatment; 2. Demonstration by HCPs on how to use the insulin pen/needle and the injection process; and 3. Resignation/surrender/acceptance of insulin, where participants felt there was no other choice but to commence insulin. ConclusionsBased on the 3 identified themes, it is important for HCPs to explain the benefits of insulin and demonstrate and explain the injection procedure to reluctant Japanese people with T2D. We also identified resignation/surrender/acceptance of insulin as a reason for treatment commencement. This study provides important information to assist HCPs in helping reluctant Japanese people with T2D to initiate basal insulin therapy.

'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.

HUBUNGAN ANTARA KARAKTERISTIK DEMOGRAFI DAN STIGMA TERKAIT DM DENGAN INISIASI INSULIN PADA PASIEN DIABETES MELLITUS TIPE II DI DAERAH PEDESAAN WILAYAH KERJA PUSKESMAS PLERET BANTUL

Relationship between Demographic Characteristics and Dm-Related Stigma with Insulin Initiation in Type II Diabetes Mellitus Patients In the Rural Area of the Pleret Health Center, Bantul Background: Recent research shows that some people with type II diabetes mellitus who use insulin experience insulin resistance (known as psychological insulin resistance). Many people with type II DM receive diabetes-related stigma based on the fact that the condition is generally more commonly seen as an emerging disease related to lifestyle. Objectives: the aim of this study was to determine a relationship between demography characteristics and stigma related to diabetes mellitus with insulin initiation in type II diabetes mellitus patients in rural areas on Pleret primary health care. Methods: Q uantitative with descriptive correlational research was used . P roportion sampling was used and 40 respondents was included . C hi square statistical tes t was performed. Results: There is a significant relationship between the monthly income of families with insulin initiation. Statistical data also showed p-value = 0.0 0 ( <0.05 ) , that the higher family income, the more risk 35 times greater experience of receiving less insulin. In addition, there is a significant relationship between DM-related stigma and insulin initiation, with p-value=0.00 ( <0.05 ) . Conclusion : There is a significant relationship between income and stigma associated with DM with insulin initiation in type II DM patients. However, these results still require deepening and are suggested for researchers to further examine other influencing factors, such as family support and the service system obtained.

Psychological Insulin Resistance: Key Factors and Intervention

Insulin is a mainstay of treatment in patients with type 2 diabetes mellitus to control blood sugar levels and reduce the risk of diabetes complications, but psychological insulin resistance can delay insulin treatment. Psychological insulin resistance can be defined as a negative attitude and feelings toward insulin treatment experienced by diabetics. Factors influencing psychological insulin resistance include a lack of understanding of diabetic pathophysiology, a negative attitude toward insulin treatment, anxiety about insulin therapy complications and hypoglycemia, distorted beliefs, daily constraints, fear or pain from injections, and discomfort. Various approaches to psychological insulin resistance involve direct demonstration of the insulin administration processes, education regarding diabetic pathophysiology and insulin action, assessment and evaluation of the degree of psychological insulin resistance, patient group training, building correct support systems, and providing contacts (e.g., diabetes center, diabetes nurse educator). The role of healthcare providers is important in reducing patients’ psychological insulin resistance through various interventions.

Psychological Insulin Resistance: Key Factors and Intervention

Insulin is a mainstay of treatment in patients with type 2 diabetes mellitus to control blood sugar levels and reduce the risk of diabetes complications, but psychological insulin resistance can delay insulin treatment. Psychological insulin resistance can be defined as a negative attitude and feelings toward insulin treatment experienced by diabetics. Factors influencing psychological insulin resistance include a lack of understanding of diabetic pathophysiology, a negative attitude toward insulin treatment, anxiety about insulin therapy complications and hypoglycemia, distorted beliefs, daily constraints, fear or pain from injections, and discomfort. Various approaches to psychological insulin resistance involve direct demonstration of the insulin administration processes, education regarding diabetic pathophysiology and insulin action, assessment and evaluation of the degree of psychological insulin resistance, patient group training, building correct support systems, and providing contacts (e.g., diabetes center, diabetes nurse educator). The role of healthcare providers is important in reducing patients’ psychological insulin resistance through various interventions.

Impact of Video Technology on the Comprehension of Patients With First Insulin Injection and the Efficiency of Nurse Education.

This study aims to compare the effectiveness of video and paper materials used for teach-back education on the first insulin injection for patients with diabetes. The study enrolled 110 patients hospitalized for diabetes who had received education on their first insulin injection in the endocrinology department. The patients were divided into an intervention group (n = 55) and a control group (n = 55) using convenience sampling. Video materials were employed for the teach-back education of the intervention group, while paper materials were employed for the teach-back education of the control group. We compared cases who answered correctly to the common parts (selection and management of injection devices, selection and rotation of injection sites, proper use of injection angles and pinching, insulin storage, injection-related complications and their prevention, selection of the correct needle length, and safe disposal of needles after use) for the first time, the number of educational sessions and total education duration between the two groups and employed the "My View on Insulin" questionnaire to survey the two groups before and 28 days after the intervention. The intervention group had a shorter total education duration than the control group, a difference that was statistically significant (p < .001). The intervention group had more advantages over the control group in terms of rotation education at the injection site (p < .05). There was no statistically significant difference in the questionnaire scores between the two groups after the intervention (p > .05); however, both groups scored significantly higher than before the intervention, a difference that was statistically significant (p < .001). The teach-back method combined with video materials applied for educating patients on their first insulin injection could reduce the education duration by healthcare providers and improve the patients' psychological insulin resistance. The key to successfully teaching patients to self-administer insulin, and allowing them to master the steps involved, is to focus on "why" rather than "what" to do.

Factors affecting the health status of patients with type 2 diabetes mellitus receiving insulin treatments: A multi-mediation path analysis: Influences on insulin-treated diabetes: Influences on insulin-treated diabetes.

To validate a hypothetical path model estimating the health status of patients with insulin-treated type 2 diabetes and to verify the mediating effects of diabetes management self-efficacy, diabetes self-management behaviour and haemoglobin A1c using a multi-mediation model. Diabetes knowledge, personal and social motivations, diabetes management self-efficacy and health behaviours may be interrelated and may directly or indirectly affect the objective and subjective health outcomes of patients with type 2 diabetes mellitus receiving insulin treatments. Model testing correlational design. The participants were 193 outpatients with insulin-treated type 2 diabetes. Data were collected between July and November 2019. The collected data were analysed using SPSS version 25.0® and AMOS 23.0. This study is based on STROBE guidelines. The model's fit indices were adequate. Diabetes-related knowledge, psychological insulin resistance, family support for diabetes management, diabetes self-care activities and haemoglobin A1c had significant direct effects on subjective health status. Diabetes management self-efficacy had significant indirect effects on subjective health status via diabetes self-care activities and haemoglobin A1c, and mediated the path through which diabetes knowledge, psychological insulin resistance and family support for diabetes management indirectly affect subjective health status. These variables explained 55.0% of the total variance of subjective health status. Diabetes knowledge, psychological insulin resistance, diabetes management family support, diabetes management self-efficacy and diabetes self-care activities were found to be related to the subjective and objective health status. The findings can help health professionals improve diabetes self-care activities and haemoglobin A1c, which will influence subjective health status in patients with type 2 diabetes mellitus, receiving insulin treatments.

RELUCTANCE OF PATIENTS WITH DIABETES MELLITUS TO INSULIN THERAPY; PSYCHOLOGICAL INSULIN RESISTANCE

Objective: To evaluate factors resulting in reluctance of initiation of insulin therapy in patients with type 2 diabetes mellitus.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Medical OPD of a private tertiary care multi-specialty hospital in Islamabad, from Apr to Jul 2019.&#x0D; Methodology: Patients with diabetes mellitus between age of 30-70 years, who had poor glycaemic control on two oral antidiabetic drugs having HbA1c&gt;9% and were insulin naïve, were included in this study. A validated questionnaire was developed which had two sections; first including the demographic data of the study populations and second having closedended dichotomous questions which were asked from patients by the treating physicians&#x0D; Results: A total of 180 patients with diabetes mellitus eligible for insulin therapy were included in the study, among them 52 (28.9%) were agreed to initiate the insulin. Negative attitude and beliefs include painful way of administration 85 (66.4%), difficult insulin storage 98 (76.6%), risk of hypoglycemia 82 (64.1%).The mean negative perception Score was 7.35 (SD 0.98).&#x0D; Conclusion: Psychological insulin resistance is present in significant diabetic population, and it is a big obstacle in insulin therapy initiation and compliance.

Overcoming psychological insulin resistance: A practical guide for healthcare professionals

Despite the demonstrated benefits of using insulin, nearly a third of the patients with type 2 diabetes (T2D) are initially reluctant to initiate insulin therapy when it is first recommended by their healthcare provider (HCP). Several studies have documented the reasons for this phenomenon known as psychological insulin resistance (PIR) and also identified actionable strategies for HCPs to assist people with T2D to overcome their PIR. However, most strategies are based on the experiences of HCPs, rather than of patients. Based on findings from a study exploring real-world patient experience around HCP actions for mitigating PIR, we suggest that HCPs use collaborative strategies throughout the course of T2D treatment to 1) explore reasons for PIR, 2) help patients overcome PIR, and 3) follow-up regarding experience with insulin.

Insulin Therapy in Type 2 Diabetes Is Associated With Barriers to Activity and Worse Health Status: A Cross-Sectional Study in Primary Care.

IntroductionMany individuals with type 2 diabetes mellitus (T2DM) experience “psychological insulin resistance”. Consequently, it could be expected that insulin therapy may have negative effects on psychological outcomes and well-being. Therefore, this study compared health status and psychosocial functioning of individuals with T2DM using only oral antihyperglycemic agents (OHA) and on insulin therapy (with or without OHA).Materials and MethodsIn this cross-sectional study, we used baseline data of a cluster randomized controlled trial conducted in 55 Dutch general practices in 2005. Health status was measured with the Short Form (SF)-36 (scale 0–100) and psychosocial functioning with the Diabetes Health Profile (DHP, scale 0-100). To handle missing data, we performed multiple imputation. We used linear mixed models with random intercepts per general practice to correct for clustering at practice level and to control for confounding.ResultsIn total, 2,794 participants were included in the analysis, their mean age was 65.8 years and 50.8% were women. Insulin-users (n = 212) had a longer duration of T2DM (11.0 versus 5.6 years) and more complications. After correcting for confounders and multiple comparisons, insulin-users reported significantly worse outcomes on vitality (SF-36, adjusted difference -5.7, p=0.033), general health (SF-36, adjusted difference -4.8, p=0.043), barriers to activity (DHP, adjusted difference -7.2, p<0.001), and psychological distress (DHP, adjusted difference -3.7, p=0.004), all on a 0-100 scale.DiscussionWhile previous studies showed similar or better health status in people with type 2 diabetes receiving insulin therapy, we found that vitality, general health and barriers to activity were worse in those on insulin therapy. Although the causality of this association cannot be established, our findings add to the discussion on the effects of insulin treatment on patient-reported outcomes in daily practice.