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

AIMS AND OBJECTIVES

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.

BACKGROUND

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.

DESIGN

Model testing correlational design.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

RELEVANCE TO CLINICAL PRACTICE

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.

Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP)

AIMS

To determine factors associated with 'hypothetical willingness' to start insulin among people with Type 2 diabetes (T2DM).

METHODS

A quantitative cross-sectional study with insulin-naïve T2DM patients at 23 primary care facilities in the Tshwane Metropolitan Municipality. Data collected included demographic and clinical data, willingness to start insulin, attitudes and barriers to insulin therapy. Factors associated with unwillingness to start insulin therapy were explored using a multivariable logistic regression model.

RESULTS

Of 468 T2DM study patients (mean age 57.2, SD = 11.3 years), more than half (51.9%) expressed unwillingness to starting insulin therapy. Unwillingness was associated with negative attitudes (OR = 1.32, 95% CI = 1.12-1.55, p = 0.001) and reluctance (OR = 1.41, 95% CI = 1.27-1.57, p < 0.001) rather than age, sex, education or diabetes duration. The strongest reasons for patient unwillingness were injection anxieties, fear of needles, insufficient knowledge of insulin, feeling unable to cope with insulin and concerns about out-of-pocket costs.

CONCLUSIONS

The prospect of insulin therapy disturbs patients' sense of self and their psychological wellbeing. The high prevalence of psychological insulin resistance among these T2DM patients needs to be addressed for effective diabetes management.