Background: Delaying insulin therapy in people with type 2 diabetes mellitus (PwT2D) often results in suboptimal glycaemic control, thus increasing rates of macro- and micro-vascular complications. The term “psychological insulin resistance” was coined, describing the negative attitudes and psychological barriers to insulin therapy in PwT2D.
Objective: In our institution (Liverpool Hospital, NSW) we sought to identify these barriers for both PwT2D and their healthcare providers (HCPs).
Methods: Subjects completed an adapted version of the validated DAWN (Diabetes Attitudes Wishes and Needs) survey. Thirty PwT2D (all inpatients) and seventy-five HCPs were recruited. Additional demographic and educational data was collected.
Results: Mean age of PwT2DM (n=30) was 64 years; mean duration of T2D 3 years. Their T2D management was 43% oral drugs, 27% injection alone and 30% on both. Of the 75 HCPs, the majority (76%) were junior doctors.
Both thought insulin would better control of T2D (PwT2D v HCP: 70% v. 92%); provide symptom benefit (79% v. 70%) and prevent future complications (89% v. 73%). Neither felt insulin therapy significantly impacted on work / home activities. HCPs were twice as likely to feel that injecting insulin would be embarrassing for PwT2D, that PwT2D would be afraid of injections and that injections would be painful. The perception of hypoglycaemia was lower in PwT2D than HCP (50% v. 61%).
Conclusion: While this group of PwT2D were open to insulin therapy, their HCPs displayed more psychological insulin resistance. While HCPs have greater knowledge of the clinical impact and side effects from insulin use, their concerns about subjective issues (such as logistical difficulties and social costs) outweighed that of PwT2D. Identifying and addressing these barriers in HCPs could lead to timely introduction of insulin therapy, thus improving glycaemic control and overall health profile of their patients.