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Abstract
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 barriers and patients' acceptance of this treatment. Subjects were asked to allocate points in 5-point scale (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.
Figures and Tables
Table 4
The comparison of PIR according to the acceptance of insulin therapy
PIR, psychological insulin resistance; Data are mean ± SD. A, group of unwilling to accept insulin therapy (group of patients who never start insulin therapy and group of patients who delay insulin therapy until failure of glycemic control with oral hypoglycemic agent); B, group of willing to accept insulin therapy (group of patients who start insulin therapy immediately). *P value < 0.05.
Table 5
The reasons for reluctance to take insulin therapy in group* of unwilling to accept insulin therapy
Table 6
The comparison of acceptance to insulin therapy according to patients' characteristics
A, group of unwilling to accept insulin therapy (group of patients who never start insulin therapy and group of patients who delay insulin therapy until failure of glycemic control with oral hypoglycemic agent); B, group of willing to accept insulin therapy (group of patients who start insulin therapy immediately). *P value < 0.05.
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