Psychological Insulin Resistance Research Articles

Psychological Insulin Resistance (PIR) Among Type 2 Diabetes Patients at Public Health Clinics in Federal Territory of Malaysia

Introduction: Insulin has been viewed as a treatment option of last resort in type 2 diabetes management. The decision to start insulin therapy is often diffi cult. Patients are usually reluctant to begin insulin and many cases delay the initiation of insulin therapy. The aim of this study is to determine the magnitude of insulin refusal or recognize as psychological insulin resistance (PIR) and to identify its predictors. Materials and Methods: This is a cross-sectional study and data was collected from two primary public health clinics in Kuala Lumpur and Putrajaya. The study sample consisted of 404 insulin naive patients with type 2 diabetes. A self-administered questionnaire was used to obtain demographic and clinical information. Results: Fifty-one percent of patients with type 2 diabetes were found to be unwilling to take insulin. Regression analysis revealed that females were 2.7 times more likely to resist insulin treatment compared to males and those with uncontrolled diabetes were 1.8 times more likely to resist insulin treatment compared to controlled diabetics. Patients will refuse insulin if they perceived their diabetes worsen with insulin use. After controlling for other attitudinal belief factors in the model, an increase in one unit of perceived disease severity will increase the likelihood of PIR around 2 times. Conclusion: Several misconceptions regarding insulin therapy were identifi ed and specifi c education intervention is recommended for successful transition to insulin therapy.

Are patients with type 2 diabetes reluctant to start insulin therapy? An examination of the scope and underpinnings of psychological insulin resistance in a large, international population

Objective:To examine the scope and underpinnings of psychological insulin resistance (PIR) across eight Western nations, with special attention to the potential influence of beliefs about insulin and broader patient beliefs regarding medications and diabetes.Methods:A total of 1400 subjects with insulin-naïve, type 2 diabetes across eight nations completed an online survey. The survey assessed willingness to start insulin, beliefs about insulin and current medications, and diabetes-related emotional distress.Results:The majority of respondents were male (59.3%), mean age was 51.6 years and mean diabetes duration was 6.1 years. A total of 17.2% reported they would be unwilling to start insulin (the PIR group), while 34.7% were ambivalent and 48.1% indicated they would be willing to do so. Marked differences by country were apparent, with PIR ranging from 5.9% (Spain) to 37.3% (Italy). Both unwilling and ambivalent patients reported significantly more negative (p < 0.001; p < 0.05) and fewer positive beliefs (p < 0.001; p < 0.01) about starting insulin, more negative feelings about their current medications (p < 0.01, p < 0.001), and more diabetes-related distress (p < 0.001; p < 0.05) than willing patients. Unwilling patients also reported significantly more negative (p < 0.05) and fewer positive beliefs (p < 0.001) about starting insulin than ambivalent patients.Conclusion:These are the first data demonstrating the prevalence of PIR across Western nations. PIR is strongly linked to positive and negative insulin beliefs, and may also reflect a broader discomfort with medications and with diabetes in general. Of note, however, PIR is a marker of behavioral intent only; it is not known whether this predicts actual behavior at the time when insulin is prescribed. When addressing patients who are reluctant to initiate insulin therapy, clinicians may find it valuable to inquire about their beliefs about insulin and their current medications.

Psychological insulin resistance: a critical review of the literature

AbstractOur objective was to conduct a critical review of the factors that account for psychological insulin resistance (PIR) and of the available strategies to reduce it.Medline, PubMed, Cochrane reviews, PsycInfo, ProQuest, Science Direct, and EBSCO databases were searched and 60 studies were included in the final review. Topics reviewed included: research methods, instruments to assess PIR, PIR in patients and in the medical care team, and proposed strategies for overcoming it.The results showed that a large number of factors account for PIR in patients. The main categories are emotional, cognitive, social/cultural, and interaction with health providers. Physicians mainly delay insulin because they lack knowledge on guidelines or pancreas physiology, they fear inducing hypoglycaemia in elderly or impaired patients, and/or they lack time or personnel resources to teach initiation. Strategies proposed to reduce PIR are educational and psychological (exposure, desensitisation, relaxation and counselling).We concluded that there is a great need of evidence‐based interventions that help remove psychological barriers about insulin use in patients, as well as in health care providers. Copyright © 2011 John Wiley &amp; Sons.

Initiating Insulin as Part of the Treating To Target in Type 2 Diabetes (4-T) Trial

OBJECTIVETo explore patients' and health professionals' experiences of initiating insulin as part of the Treating To Target in Type 2 Diabetes (4-T) randomized controlled trial.RESEARCH DESIGN AND METHODSInterviews were conducted with 45 trial participants and 21 health professionals and thematically analyzed.RESULTSPatients were generally psychologically insulin receptive when approached to participate in the 4-T trial. Their receptiveness arose largely from their personal experiences observing intensifying prior treatments and deteriorating blood glucose control over time, which led them to engage with and accept the idea that their diabetes was progressive. Health professionals also fostered receptiveness by drawing on their clinical experience to manage patients' anxieties about initiating insulin.CONCLUSIONSPrevious studies may have overemphasized the problem of psychological insulin resistance and overlooked factors and treatment experiences that may promote insulin receptiveness among type 2 patients.

Factors Associated With Psychological Insulin Resistance in Individuals With Type 2 Diabetes

OBJECTIVETo describe the predictive relationships of selected sociodemographic, biomedical, and psychosocial variables to reluctance to use insulin among patients with type 2 diabetes.RESEARCH DESIGN AND METHODSA total of 178 patients with type 2 diabetes participated in this cross-sectional, observational study. Data were obtained by patient interview using validated measures of diabetes attitude, knowledge, self-efficacy, care communication, and perceived barriers to treatment, as well as sociodemographic and biomedical data.RESULTSWomen and ethnic minorities with type 2 diabetes have more psychological barriers to insulin treatment (P < 0.05). The final regression model showed that individuals who believed in the value of tight glucose control, had strong self-efficacy, and had better interpersonal processes with their healthcare providers were less reluctant to use insulin treatment (R2 = 0.403; P < 0.0001).CONCLUSIONSDiabetes self-efficacy and better interaction with clinicians were important in decreasing patients' reluctance to use insulin, known as psychological insulin resistance.

Insulin therapy and quality of life. A review

Three central goals in the treatment of diabetes mellitus are (1) the avoidance of hyperglycaemia to prevent the development or progression of diabetes complications over time, (2) the avoidance of hypoglycaemia and (3) the maintenance or achievement of good quality of life. Insulin is the most powerful agent that can be used to control blood glucose levels. This article reviews the studies that have investigated the effects of different types of insulin and insulin delivery techniques on quality of life of patients with type 1 or type 2 diabetes. First, the concept of 'quality of life' (QoL) is defined and different ways of measuring QoL are explained. Secondly, the effects of different aspects of insulin therapy on QoL are reviewed: (1) the phenomenon of 'psychological insulin resistance'; (2) the effects of different types of insulin: regular insulin versus short-acting insulin analogues, long-acting insulin analogues or biphasic mixtures; (3) multiple daily injections versus pump therapy. Having multiple complications of diabetes is clearly associated with decreased QoL. Results from large studies such as the Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS) suggest that intensive treatment itself does not impair QoL. Recent findings further suggest that pump therapy, compared to multiple daily injections, has beneficial effects on QoL. The fact that multiple tools are used to assess QoL makes it difficult to draw conclusions regarding the effects of different types of insulin on QoL. More work on the standardization of the assessment of QoL in diabetes is urgently needed.

Psychological insulin resistance: patient beliefs and implications for diabetes management

To define and understand patient psychological insulin resistance (PIR) and its impact on diabetes management. Systematic literature review of peer-refereed journals using the MEDLINE database, including all articles in English from 1985 to 2007. The population included patients with type 1 and type 2 diabetes, insulin naïve, and those currently using insulin. A total of 116 articles were reviewed. PIR is impacted by patients' beliefs and knowledge about diabetes and insulin, negative self-perceptions and attitudinal barriers, the fear of side effects and complications from insulin use, as well as lifestyle adaptations, restrictions required by insulin use, and social stigma. These etiological influences, both independently and in combination, constitute a patient's PIR and may result in the reluctance of patients to both initiate and intensify treatment, leading to delayed treatment initiation and compromised glucose control. PIR is complex and multifaceted. It plays an important, although often ignored, role in diabetes management. Assisting health care professionals in better understanding PIR from the patient's perspective should result in improved treatment outcomes. By tailoring treatments to patients' PIR, clinicians may be better able to help their patients begin insulin treatment sooner and improve compliance, thus facilitating target glycemic control.

Measuring Psychological Insulin Resistance

The purpose of this study is to explore the attitudes that contribute to psychological insulin resistance (PIR) in insulin-naive patients with type 2 diabetes and to identify predictors of PIR. A prospective study using 2 self-report surveys and incorporating demographic and health variables was conducted to determine the prevalence of PIR among a sample of 100 adult, insulin-naive patients with type 2 diabetes at an outpatient diabetes center in a university-affiliated teaching hospital. Thirty-three percent of patients with type 2 diabetes were unwilling to take insulin. The most commonly expressed negative attitudes were concern regarding hypoglycemia, permanent need for insulin therapy, less flexibility, and feelings of failure. Less than 40% expressed fear of self-injection or thought that injections were painful. However, compared with willing subjects, unwilling subjects were more likely to fear injections and thought injections would be painful, life would be less flexible, and taking insulin meant health would deteriorate (P< .005 for all comparisons). Poorer general health and higher depression scores also correlated with PIR. The results of the surveys, which were generally consistent, identified several remediable misconceptions regarding insulin therapy and suggest targets for educational interventions.

A Study on Resistance in Type 2 Diabetic Patient Against Commencement of Insulin Treatment

Background: To achieve tight glycemic control in the poorly controlled type 2 diabetic patients with oral hypoglycemic agent, it maybe beneficial to initiate insulin treatment at the early stage. Many patients with type 2 diabetes are often reluctant to begin insulin therapy despite poor glycemic control with oral hypoglycemic agents, this little known phenomenon, often termed 'psychological insulin resistance (PIR)'. This study investigates psychological insulin resistance in Korean patients with type 2 diabetes. Method: This study examined a total of 76 type 2 diabetic patients with poor glycemic control during period of April to July 2006. Through questionnaire and telephone survey, total 24 questions were asked about various attitudes on insulin therapy including psychological ba rriers and patients' acceptance of this treatment. Subjects were asked to allocate points in 5-point sc ale (from 5 points for 'very true' to 1 point for 'very untrue'). Results: The means of psychological rejection, injection-related anxiety and fear of insulin side effects such as hypoglycemia and weight gain were 3.65 ± 0.92, 3.17 ± 0.98 and 2.8 ± 1.02, respectively. Unwillingness was common in insulin therapy, 67% of patient rejected or was unwilling to take insulin. Main reasons of patients most frequently endorsed beginning insulin indicate that disease is worsening, permanence (once you start insulin you can never quit) and sense of personal failure. Furthermore, study indicates that patients' reasons for avoiding insulin therapy were mainly psychological rejection, which extended far beyond a simple injection related anxiety. Conclusion: PIR was psychological reluctance rather than injection related anxiety. To overcome these psychological barriers to insulin treatment, it is necessary to address appropriate diabetes education including training and counseling with excellent interactive communications between patients and clinicians. (KOREAN DIABETES J 32:269-279, 2008)

Spring 2007 Meeting of the Association of British Clinical Diabetologists

Spring 2007 Meeting of the Association of British Clinical Diabetologists

Psychological Insulin Resistance Scope of the Problem

Psychological Insulin Resistance Scope of the Problem

Provider Psychological Insulin Resistance

Provider Psychological Insulin Resistance

Development and Validation of a New Measure to Evaluate Psychological Resistance to Insulin Treatment

To develop a psychometric questionnaire to measure psychological barriers to insulin treatment in patients with type 2 diabetes. Scale development was based on principal component analyses in two cross-sectional studies of insulin-naïve patients with type 2 diabetes. The structure of the questionnaire was developed in the first sample of 448 patients and subsequently cross-validated in an independent sample of 449 patients. Analyses in the first sample yielded five components that accounted for 74.5% of the variance based on 14 items and led to the following subscales: fear of injection and self-testing, expectations regarding positive insulin-related outcomes, expected hardship from insulin treatment, stigmatization by insulin injections, and fear of hypoglycemia. In addition, an overall sum score of all values was calculated. The structure of the questionnaire was cross-validated in the second sample, with almost identical component loadings and an explained variance of 69.4%. An additional confirmatory factor analysis also indicated an acceptable to good model fit with root mean square error of approximation equal to 0.04 and comparative fit index equal to 0.97. Coefficients of reliability (Cronbach's alpha 0.62-0.85 and 0.78 for overall sum score) were acceptable, considering the very small number of items for each scale. The Barriers to Insulin Treatment Questionnaire appears to be a reliable and valid measure of psychological insulin resistance in patients with type 2 diabetes. This short instrument is easy to administer and may be used by both clinicians and researchers to assess the psychological barriers to insulin treatment.

Insulin Treatment and the Problem of Weight Gain in Type 2 Diabetes

Insulin therapy has been shown to benefit the prognosis in patients with type 2 diabetes, but its initiation and intensification is often delayed through concerns about hypoglycemia and weight gain. In addition, weight gain is linked to the pathophysiology of type 2 diabetes and contributes to the overall risk for adverse cardiovascular outcomes. This article attempts to summarize this issue and examine the options available for weight management. A broad range of literature has been reviewed to distill important, consistent facts about insulin and weight gain and the options available for limiting the problem. Unfortunately, the great benefits of insulin therapy may be potentially undermined by weight gain. Weight gain is physiologically and psychologically undesirable, especially in patients with diabetes who are already overweight. The fear of weight gain with some medications contributes to psychological insulin resistance, which may discourage patients from commencing or following insulin regimens. However, new diabetes treatments and lifestyle interventions can be used to mitigate these problems. The exact choice of insulin and oral medications and weight loss interventions are important considerations in the overall management of patients with type 2 diabetes. Changes in a patient's lifestyle, such as modifications to diet and implementing an exercise program, are first-line treatments for type 2 diabetes and can also counteract insulin-induced weight gain.

Psychological Insulin Resistance: Overcoming Barriers to Starting Insulin Therapy

Psychological Insulin Resistance: Overcoming Barriers to Starting Insulin Therapy

Psychological Insulin Resistance in Patients With Type 2 Diabetes

To achieve tight glycemic control in type 2 diabetic patients, it may be advantageous to introduce insulin therapy much earlier in the disease course (1). Unfortunately, many patients are reluctant to begin insulin and may delay starting insulin therapy for significant periods of time (2,3). Recent evidence suggests that more than one-quarter of patients may refuse insulin therapy once it is prescribed (4). Little is actually known about this phenomenon, often termed “psychological insulin resistance” (PIR), how common it may be, or why patients feel this way. Therefore, we developed and distributed a PIR self-report survey to a large multicity sample of patients with type 2 diabetes who were not taking insulin. The survey examined their willingness to take insulin if it was prescribed and to identify perceived attitudinal barriers to insulin therapy. Participants at several 1-day conferences for people with diabetes (Taking Control of Your Diabetes) conducted in San Diego, California; Raleigh, North Carolina; Portland, Oregon; Minneapolis, Minnesota; Philadelphia, Pennsylvania; and Honolulu and Hilo, Hawaii completed an anonymous one-page survey concerning insulin attitudes. At the beginning of each conference, an announcement to all participants explained the study, directed them to the questionnaire in their conference syllabus, and asked them to return completed surveys before the conference’s conclusion. The study was approved by the Committee on Human Research at the University of California, San Francisco. An initial questionnaire item assessed willingness to begin insulin therapy, rated from very willing to not unwilling. Patients also rated on a six-point …

Type 2 Diabetes – Failure, Blame and Guilt in the Adoption of Insulin Therapy

Type 2 Diabetes is a progressive disease with an insidious onset, including decreased first-phase insulin secretion and mild forms of hyperinsulinemia caused by heterogenous factors such as genetic make-up, obesity and lifestyle. Decreased insulin secretion may already be a first sign of beta-cell damage, which is expected to develop into insulin resistance later and to result in progressive beta-cell deterioration and death. The disease has become highly prevalent in Western countries and is rapidly reaching epidemic proportions in the developing world. While the molecular mechanisms involved in the etiology of this disease remain relatively poorly understood, the United Kingdom Prospective Diabetes Study (UKPDS) has clearly demonstrated in several investigations that the adoption of insulin therapy in early phases of the disease is capable of attenuating or even preventing massive beta-cell loss and thus the severe metabolic syndrome and its late complications. This report aims to highlight the common psychological obstacles healthcare professionals are faced with when they are attempting early introduction of insulin therapy. Many patients typically underrate early signs and repress the fact that the disease is developing while they are vainly attempting to keep to lifestyle changes like New Year's resolutions. However, there is also reluctance on the part of the healthcare professionals. At the same time, patients' reservations about needles and fear of hypoglycemia can be removed simply by educating patients about the relatively low risk of hypoglycemia. Coupled with enhanced healthcare services, this strategy can overcome psychological insulin resistance and contribute to the maintenance of good metabolic control.

Psychological barriers.

Type 2 diabetes treatment outcomes ultimately depend on patients and their ability to make long-term behavioural changes that support good self-care and metabolic control. Patients' perceptions about diabetes and diabetes-related complications can have a strong influence on their emotional well-being, as well as day-to-day self-care and the quality of metabolic control. The gravity of diabetes is often underestimated, and many patients do not understand the link between poor glycaemic control and long-term complications of the disease. Similarly, people with diabetes commonly undervalue the role of lifestyle changes and pharmacological therapy in preventing future complications. Negative emotions and preconceptions about treatment can also discourage adherence to treatment plans. 'Psychological insulin resistance' caused by fear and concerns about insulin and daily insulin injections can discourage many patients from starting insulin therapy, even if oral agents have failed. Depression, stress and anxiety represent further obstacles to optimum self-care and the attainment of glucose goals. Healthcare professionals should endeavour to understand and accommodate these issues when setting personal treatment goals and developing plans to achieve them. Importantly, the advice and support they provide should be tailored to the unique needs of each patient. There is scope to improve outpatient consultations to ensure agreement between patients and professionals concerning issues discussed and decisions made, and this may help to improve recall and motivation to manage diabetes. Engaging patients in the goal-setting process can help to overcome potential barriers to good self-care and may increase the probability that treatment goals are achieved.

People with type 2 diabetes facing the reality of starting insulin therapy: factors involved in psychological insulin resistance

AbstractPsychological insulin resistance has drawn increasing attention, due to its multiple implications, to the patient's well‐being, and also to the overall costs of diabetes management. Exploratory studies have emphasised, as main psychological barriers, needle phobia, fear of hypoglycaemia or weight gain, or impaired patient–health care team communication. This study addresses psychological insulin resistance from the qualitative point of view. We analysed 18 people with type 2 diabetes, at the moment of initiating insulin therapy. The methodology was a qualitative one, including phenomenological analysis and content analysis of the semi‐structured interviews. The results show that the most salient contributors to psychological insulin resistance are: the mental representations (patients' personal view of reality) of the reasons for the necessity to start insulin therapy (e.g. incorrect medical decision); the perceived consequences of the treatment (e.g. social rejection); and the factors which contributed to the decision to refuse or accept the treatment (e.g. family, other people with diabetes). Other factors which contribute to the decision regarding insulin therapy are the presence of concomitant diseases and the acute discomfort generated either by hyperglycaemia or by the previous medication.There is an increased need to study this issue in culturally sensitive settings, because of the important role played by the social environment in the adaptation to an intrusive chronic treatment. Copyright © 2004 John Wiley &amp; Sons, Ltd.

Focus on psychological insulin resistance in people with type 2 dibetes

Focus on psychological insulin resistance in people with type 2 dibetes