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Hidaka T, Suzuki R, Hashimoto K, Inoue M, Terada Y, Endo S, Kakamu T, Gunji M, Abe K, Fukushima T. Perceived Future Outcomes of Unsuccessful Treatment and Their Association with Treatment Persistence Among Type-2 Diabetes Patients: A Cross-Sectional Content Analysis. Diabetes Ther 2023:10.1007/s13300-023-01433-1. [PMID: 37340230 PMCID: PMC10363091 DOI: 10.1007/s13300-023-01433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Despite the known strong association between patients' knowledge of outcomes of type 2 diabetes mellitus (T2DM) and treatment persistence, this knowledge in this patient population requires further clarification. The aim of our study was to reveal the perception of unsuccessful treatment outcomes among patients with T2DM and its association with treatment persistence by analysing answers to open-ended questions. METHODS In this cross-sectional study, 106 patients with T2DM who lived in Fukushima Prefecture, Japan, had a medical record in the Fukushima National Health Insurance Organisation database and had no cognitive problems were enrolled by purposive sampling. Treatment status was defined as "non-persistent" when a participant's treatment medical record was absent for a continuous period of ≥ 6 months; otherwise, it was referred to as "persistent". We asked about the possible future problems of untreated T2DM, inductively classified the open answers into 15 codes and then statistically examined the association between these codes and treatment persistence using logistic regression analysis adjusted for age and sex. RESULTS Persistent treatment was prevalent among participants who mentioned the code "treatment", which encompasses the terms that indicated invasiveness, such as dialysis, insulin injection, and shots (odds ratio 4.339; 95% confidence interval 1.104-17.055). CONCLUSION Persistent treatment was prevalent among patients with T2DM who mentioned the code "treatment", suggesting that these patients may anticipate a threat due to the invasiveness of diabetes and thus participate in persistent treatment to avoid this threat. Healthcare professionals should provide appropriate information and supportive conditions to achieve both a reduced feeling of threat and persistent treatment engagement.
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Affiliation(s)
- Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Hikarigaoka 1, Fukushima, Fukushima, 9601295, Japan.
| | - Rieko Suzuki
- Koriyama City Public Health Center, 15-1, Asahi 2, Koriyama, Fukushima, 9638024, Japan
| | - Katsue Hashimoto
- Koriyama City Public Health Center, 15-1, Asahi 2, Koriyama, Fukushima, 9638024, Japan
| | - Mariko Inoue
- CMR Development Division, Novo Nordisk Pharma Ltd., 2-1-1, Marunouchi, Chiyoda-ku, Tokyo, 1000005, Japan
| | - Yukiko Terada
- CMR Development Division, Novo Nordisk Pharma Ltd., 2-1-1, Marunouchi, Chiyoda-ku, Tokyo, 1000005, Japan
| | - Shota Endo
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Hikarigaoka 1, Fukushima, Fukushima, 9601295, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Hikarigaoka 1, Fukushima, Fukushima, 9601295, Japan
| | - Mariko Gunji
- Koriyama City Public Health Center, 15-1, Asahi 2, Koriyama, Fukushima, 9638024, Japan
| | - Koichi Abe
- Igarashi Clinic of Medicine and Surgery, 12-7, Namiki 2, Koriyama, Fukushima, 9638026, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, Hikarigaoka 1, Fukushima, Fukushima, 9601295, Japan
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Holmes-Truscott E, Holloway EE, Lam B, Baptisa S, Furler J, Hagger V, Skinner T, Speight J. 'Is Insulin Right for Me?': web-based intervention to reduce psychological barriers to insulin therapy among adults with non-insulin-treated type 2 diabetes - a randomised controlled trial. Diabet Med 2023:e15117. [PMID: 37052584 DOI: 10.1111/dme.15117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/14/2023]
Abstract
AIMS To test 'Is Insulin Right for Me?', a theory-informed, self-directed, web-based intervention designed to reduce psychological barriers to insulin therapy among adults with type 2 diabetes. Further, to examine resource engagement and associations between minimum engagement and outcomes. METHODS Double-blind, two-arm randomised controlled trial (1:1), comparing the intervention with freely available online information (control). Eligible participants were Australian adults with type 2 diabetes, taking oral diabetes medications, recruited primarily via national diabetes registry. EXCLUSION CRITERIA prior use of injectable medicines; being 'very willing' to commence insulin. Data collections were completed online at baseline, two-week and six-month follow-up. PRIMARY OUTCOME negative Insulin Treatment Appraisal Scale (ITAS) scores; secondary outcomes: positive ITAS scores and hypothetical willingness to start insulin. ANALYSES intention-to-treat (ITT); per protocol (PP) examination of outcomes by engagement. TRIAL REGISTRATION ACTRN12621000191897 RESULTS: No significant ITT between-arm (intervention: n=233; control: n=243) differences were observed in primary (two weeks: Mdiff [95% CI]: -1.0 [-2.9 to 0.9]; six months: -0.01 [-1.9 to 1.9]), or secondary outcomes at either follow-up. There was evidence of lower Negative ITAS scores at two-week, but not six-month, follow-up among those with minimum intervention engagement (achieved by 44%) compared to no engagement (-2.7 [ -5.1 to -0.3]). CONCLUSIONS Compared to existing information, 'Is insulin right for me?' did not improve outcomes at either timepoint. Small intervention engagement effects suggest it has potential. Further research is warranted to examine whether effectiveness would be greater in a clinical setting, following timely referral among those for whom insulin is clinically indicated.
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Affiliation(s)
- Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes, 570 Elizabeth Street, Melbourne, Victoria, Australia
| | - Edith E Holloway
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes, 570 Elizabeth Street, Melbourne, Victoria, Australia
| | - Benjamin Lam
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes, 570 Elizabeth Street, Melbourne, Victoria, Australia
- Education Futures, University of South Australia, 61-68 North Terrace, Adelaide, South Australia, Australia
| | - Shaira Baptisa
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes, 570 Elizabeth Street, Melbourne, Victoria, Australia
| | - John Furler
- Department of General Practice, The University of Melbourne, 780 Elizabeth St, Melbourne, Victoria, Australia
| | - Virginia Hagger
- School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation (Deakin University), Geelong, VIC, Australia
| | - Timothy Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes, 570 Elizabeth Street, Melbourne, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Edwards Rd, Flora Hill, Victoria, Australia
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 København, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, 1 Gheringhap St, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes, 570 Elizabeth Street, Melbourne, Victoria, Australia
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Hernández-García F, González-Velázquez VE, Pérez García ER, Lazo Herrera LA, Pedraza-Rodríguez EM, Pupo Pérez A, González Quintana P, Casanovas Figueroa J. Validation and application of the Insulin Treatment Appraisal Scale in Cuban patients with type 2 diabetes mellitus. ENDOCRINOL DIAB NUTR 2022; 69:791-801. [PMID: 36443192 DOI: 10.1016/j.endien.2021.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/08/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The purpose of this study was to validate the Insulin Treatment Appraisal Scale (ITAS) in the Cuban population with type 2 diabetes mellitus. MATERIAL AND METHODS A cross-sectional, multicentre analytical study was performed in Cuba from February 2020 to April 2021; 199 patients were surveyed in a hospital institution and in primary healthcare. We used the Insulin Treatment Appraisal Scale, consisting of 20 items, with a minimum score of 20 points and a maximum of 100, where the higher the score, the worse the perception of insulin therapy. The validity of the instrument was determined by means of an exploratory factor analysis. The internal consistency and reliability of the scale were calculated by means of Cronbach's alpha coefficient. A K-means cluster analysis was performed to establish a cut-off point for poor perception of insulin therapy. RESULTS The exploratory factor analysis supported the validity of the instrument, with a Cronbach's alpha of 0.747. There were statistically significant differences between patients under insulin and non-insulin treatment in terms of the answers given in all items of the scale. The total mean score obtained was 51.96 ± 10.78, and it was lower in insulin users compared to those who used other drugs (49.79 ± 10.07 vs 55.09 ± 11.12). A score ≥65 was proposed as a cut-off point for poor perception of insulin therapy. A positive relationship was found between the body mass index values and the total score of the scale. Being female and current treatment not involving insulin were factors associated with low perception of insulin therapy. CONCLUSIONS The instrument proved to be valid for the population in which it was applied. Insulin users turned out to be the ones with the best perception about its use. A cut-off point of ≥65 points for poor perception of insulin treatment was proposed for evaluation and comparison in future studies in other patient populations.
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Affiliation(s)
- Frank Hernández-García
- Centro Provincial de Atención y Educación al Paciente Diabético, Hospital Provincial General Docente Dr. Antonio Luaces Iraola, Facultad de Ciencias Médicas Dr. José Assef Yara, Universidad de Ciencias Médicas de Ciego de Ávila, Ciego de Ávila, Cuba.
| | | | - Enrique Rolando Pérez García
- Policlínico Universitario Área Norte, Facultad de Ciencias Médicas Dr. José Assef Yara, Universidad de Ciencias Médicas de Ciego de Ávila, Ciego de Ávila, Cuba
| | - Luis Alberto Lazo Herrera
- Facultad de Ciencias Médicas Dr. Ernesto Che Guevara de la Serna, Universidad de Ciencias Médicas de Pinar del Río, Pinar del Río, Cuba
| | | | - Antonio Pupo Pérez
- Facultad de Ciencias Médicas General Calixto García, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
| | | | - Jany Casanovas Figueroa
- Centro Provincial de Atención y Educación al Paciente Diabético, Hospital Provincial General Docente Dr. Antonio Luaces Iraola, Facultad de Ciencias Médicas Dr. José Assef Yara, Universidad de Ciencias Médicas de Ciego de Ávila, Ciego de Ávila, Cuba
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Ngassa Piotie P, Muchiri JW, Webb EM, Rheeder P. Assessing barriers to insulin therapy among people with type 2 diabetes in South Africa using the Insulin Treatment Appraisal Scale: A cross-sectional survey. Prim Care Diabetes 2022; 16:509-514. [PMID: 35690550 DOI: 10.1016/j.pcd.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/20/2021] [Accepted: 05/27/2022] [Indexed: 11/23/2022]
Abstract
AIMS To assess barriers to insulin therapy among people with type 2 diabetes after adapting the Insulin Treatment Appraisal Scale (ITAS) to the South African context. METHODS A panel of experts reviewed the original ITAS for clarity and relevance to the South African context. The ITAS was administered to 253 adults with type 2 diabetes attending diabetes outpatient clinics in the Tshwane Metropolitan Municipality. Internal consistency (Cronbach's alpha) was tested and construct validity was examined using exploratory factor analysis (EFA). PIR was appraised in insulin users and non-users. RESULTS The EFA revealed that the adapted ITAS had a two-factor structure, similar to the original scale, with acceptable internal consistency (α = 0.85). Insulin-using participants had significantly less negative attitudes to insulin therapy than non-users (40.7 ± 7.1 vs. 51.5 ± 11.2, p < 0.001). Compared to participants who used insulin, participants who did not use insulin were afraid of injecting themselves with a needle (71% vs. 11%, p < 0.001) and saw insulin treatment as a sign of worsening diabetes (63% vs. 29%, p < 0.001). CONCLUSIONS Consistent with previous studies, participants who were not using insulin had more negative beliefs and attitudes towards insulin treatment than those who were already using insulin. South African clinicians should use the ITAS to assess positive and negative perceptions regarding insulin therapy in both insulin-naïve and insulin-treated people, to evaluate interventions to reduce PIR and improve treatment outcomes.
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Affiliation(s)
- Patrick Ngassa Piotie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, 0007 City of Tshwane, South Africa.
| | - Jane W Muchiri
- Department of Human Nutrition, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, 0007 City of Tshwane, South Africa.
| | - Elizabeth M Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, 0007 City of Tshwane, South Africa.
| | - Paul Rheeder
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag X323, Arcadia, 0007 City of Tshwane, South Africa.
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Okazaki K, Takahashi N, Shingaki T, Perez-Nieves M, Stuckey H. Key factors for overcoming psychological insulin resistance: A qualitative study in Japanese people with type 2 diabetes. Prim Care Diabetes 2022; 16:411-416. [PMID: 35256314 DOI: 10.1016/j.pcd.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
AIMS We report the key factors that motivate reluctant Japanese people with type 2 diabetes (T2D) to initiate insulin treatment. METHODS Participants 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. RESULTS Participant 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. CONCLUSIONS Based 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.
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Affiliation(s)
- Kentaro Okazaki
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Noriyuki Takahashi
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Tomotaka Shingaki
- Eli Lilly Japan K.K., 5-1-28 Isogami-dori, Chuo-ku Kobe, Hyogo 651-0086, Japan.
| | - Magaly Perez-Nieves
- Eli Lilly and Company, Global Headquarters Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - Heather Stuckey
- Pennsylvania State University, College of Medicine, 201 Old Main, University Park, PA 16802, USA.
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Snoek FJ, Fisher L, Polonsky WH, Stuckey H, Hessler D, Tang T, Hermanns N, Mundet X, Silva M, Sturt J, Okazaki K, Hadjiyianni I, Desai U, Perez-Nieves M. Overcoming psychological insulin resistance: A practical guide for healthcare professionals. Prim Care Diabetes 2021; 15:619-621. [PMID: 33785288 DOI: 10.1016/j.pcd.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Frank J Snoek
- Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, La Jolla, CA, USA
| | | | | | - Tricia Tang
- University of British Columbia, Vancouver, Canada
| | | | - Xavier Mundet
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Maria Silva
- Instituto Multidisciplinar de Medicina, Sao Paulo, Brazil
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Ngassa Piotie P, Wood P, Webb EM, Marcus TS, Rheeder P. Willingness of people with Type 2 diabetes to start insulin therapy: Evidence from the South African Tshwane Insulin Project (TIP). Diabetes Res Clin Pract 2020; 168:108366. [PMID: 32791159 DOI: 10.1016/j.diabres.2020.108366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/22/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Patrick Ngassa Piotie
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Paola Wood
- Division of Biokinetics, Department of Physiology, Faculty of Health Sciences, University of Pretoria, P/Bag 14760, Hatfield 0001, City of Tshwane, South Africa.
| | - Elizabeth M Webb
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Tessa S Marcus
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
| | - Paul Rheeder
- Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia 0007, City of Tshwane, South Africa.
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Balogh EG, Perez-Nieves M, Cao D, Hadjiyianni II, Ashraf N, Desai U, Snoek FJ, Sturt JA. Key Strategies for Overcoming Psychological Insulin Resistance in Adults with Type 2 Diabetes: The UK Subgroup in the EMOTION Study. Diabetes Ther 2020; 11:1735-1744. [PMID: 32562245 PMCID: PMC7376995 DOI: 10.1007/s13300-020-00856-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION Many patients with type 2 diabetes mellitus (T2DM) delay initiation of insulin therapy despite healthcare professional (HCP) advice. This phenomenon has been referred to as 'psychological insulin resistance' (PIR), and various contributing factors have been identified. Studies discussing approaches to overcoming PIR are lacking. Our aim was to identify the key strategies used by HCPs that most helped adults with T2DM and PIR in the UK to initiate insulin. METHODS As part of a global study, UK adults with T2DM and PIR were recruited (N = 125) to take a survey that included 38 HCP statements and actions about insulin initiation. Data assessed were perceived occurrence and helpfulness of these strategies in facilitating insulin initiation. RESULTS The most helpful strategies involved demonstrating the injection process (e.g. HCP talked patient through the process of taking insulin [83.6%]) and adopting a collaborative approach (HCP encouraged patient to contact the clinic immediately in case of any problems/questions [80.5%]). Additionally, HCPs highlighting the benefits of insulin (HCP explained that insulin was a natural substance needed by patient's body [81.2%]) and allaying patients' concerns (HCP explained that patient might not have to take insulin forever [78.0%]) helped patients initiate insulin. The least helpful action was HCPs repeatedly persuading patients to initiate insulin (40.9%). CONCLUSIONS The study recommends key strategies that HCPs can adopt to help adults with T2DM overcome PIR in the UK.
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Affiliation(s)
| | | | | | | | | | | | - Frank J Snoek
- Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Jackie A Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Okazaki K, Shingaki T, Cai Z, Perez-Nieves M, Fisher L. Successful Healthcare Provider Strategies to Overcome Psychological Insulin Resistance in Japanese Patients with Type 2 Diabetes. Diabetes Ther 2019; 10:1823-1834. [PMID: 31286432 PMCID: PMC6778551 DOI: 10.1007/s13300-019-0664-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION EMOTION was a multinational, noninterventional study surveying current insulin-using adults with type 2 diabetes mellitus (T2D) who were initially reluctant to begin insulin treatment. In this Japanese population subanalysis of EMOTION, we identify the frequency and level of helpfulness of healthcare provider (HCP) actions, and we analyze life events ('actions/events') that assist T2D patients with psychological insulin resistance in the decision to initiate insulin. METHODS Participants were selected from Survey Sampling International and their local partners' market research panels in Japan. Quantitative surveys were administered between December 2016 and August 2017 to patients who met the study criteria. Participants were asked whether 45 actions/events occurred, and to rate the level of helpfulness of the actions/events in contributing to their decision to initiate insulin. RESULTS Among the 594 eligible participating adults in the EMOTION study, 99 were from Japan. Despite initial reluctance to begin insulin treatment, 80.8% of the Japanese participants immediately commenced insulin. Practical demonstrations by HCPs on how to use insulin were rated by participants as most helpful. Examples of such practical demonstrations, reported as helping moderately or a lot, were 'HCP walked patient through the process of exactly how to take insulin' (82.8%), 'HCP showed an insulin pen' (79.7%), and 'HCP helped patient to see how simple it was to inject insulin' (79.1%). CONCLUSION This study identifies actions that HCPs can use to assist Japanese patients in deciding whether to initiate insulin. These findings may aid the development of clinical interventions addressing reluctance to begin insulin treatment among Japanese patients with T2D. FUNDING Eli Lilly and Company and Boehringer Ingelheim. Plain language summary available for this article.
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Affiliation(s)
- Kentaro Okazaki
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Tomotaka Shingaki
- Eli Lilly Japan K.K., 5-1-28 Isogami-dori, Chuo-ku, Kobe, Hyogo, 651-0086, Japan.
| | - Zhihong Cai
- Eli Lilly Japan K.K., 5-1-28 Isogami-dori, Chuo-ku, Kobe, Hyogo, 651-0086, Japan
| | | | - Lawrence Fisher
- Behavioral Diabetes Institute, 5405 Oberlin Drive Suite 100, San Diego, CA, 92121, USA
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Polonsky WH, Fisher L, Hessler D, Stuckey H, Snoek FJ, Tang T, Hermanns N, Mundet X, Silva M, Sturt J, Okazaki K, Hadjiyianni I, Cao D, Ivanova J, Desai U, Perez-Nieves M. Identifying solutions to psychological insulin resistance: An international study. J Diabetes Complications 2019; 33:307-314. [PMID: 30709604 DOI: 10.1016/j.jdiacomp.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/16/2018] [Accepted: 01/08/2019] [Indexed: 02/06/2023]
Abstract
AIMS To identify actions of healthcare professionals (HCPs) that facilitate the transition to insulin therapy (IT) in type 2 diabetes (T2D) adults. METHODS Included were T2Ds in seven countries (n = 594) who reported initial IT reluctance but eventually began IT. An online survey included 38 possible HCP actions: T2Ds indicated which may have occurred and their helpfulness. Also reported were delays in IT start after initial recommendation and any period of IT discontinuation. RESULTS Exploratory factor analysis of HCP actions yielded five factors: "Explained Insulin Benefits" (EIB), "Dispelled Insulin Myths" (DIM), "Demonstrated the Injection Process" (DIP), "Collaborative Style" (CS) and "Authoritarian Style" (AS). Highest levels of helpfulness occurred for DIP, EIB and CS; lowest for AS. Participants who rated DIP as helpful were less likely to delay IT than those who rated DIP as less helpful (OR = 0.75, p = 0.01); participants who rated CS and EIB as helpful were less likely to interrupt IT than those who rated these as less helpful (OR = 0.55, p < 0.01; OR = 0.51, p = 0.01, respectively). CONCLUSIONS Three key HCP actions to facilitate IT initiation were identified as helpful and were associated with more successful initiation and persistence. These findings may aid the development of interventions to address reluctance to initiating IT.
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Affiliation(s)
- William H Polonsky
- University of California, San Diego, La Jolla, CA, USA; Behavioral Diabetes Institute, San Diego, CA, USA.
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Frank J Snoek
- Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands
| | - Tricia Tang
- University of British Columbia, Vancouver, Canada
| | | | - Xavier Mundet
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Maria Silva
- Instituto Multidisciplinar de Medicina, Sao Paulo, Brazil
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11
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Lee KP. Translation and validation of the Insulin Treatment Appraisal Scale in Hong Kong primary care patients. J Diabetes Investig 2018; 9:311-320. [PMID: 28626953 PMCID: PMC5835470 DOI: 10.1111/jdi.12704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/22/2017] [Accepted: 06/04/2017] [Indexed: 11/24/2022] Open
Abstract
AIMS/INTRODUCTION Patients with type 2 diabetes mellitus often delay the initiation or titration of insulin treatment due to psychological factors. This phenomenon is referred to as psychological insulin resistance (PIR). The Insulin Treatment Appraisal Scale (ITAS) is a 20-item instrument for assessing PIR. A previous Chinese version of the ITAS (C-ITAS) was found to be subject to problems arising from its translation. The present study aimed to translate and validate this instrument, which will facilitate research and aid in counseling in a clinical setting. MATERIALS AND METHODS The C-ITAS was modified to develop the Hong Kong version of the C-ITAS (C-ITAS-HK) according to published guidelines for the translation of transcultural research. A total of 328 diabetes mellitus patients who were followed-up in 10 different publically funded primary care outpatient clinics were recruited for self-administration of the C-ITAS-HK. Demographic data were recorded, and clinical data (e.g., presence of diabetes mellitus complications) were obtained from case records. The C-ITAS-HK results were subjected to psychometric analysis, including the assessment of Cronbach's alpha, factor analysis and test-retest reliability. RESULTS Factor analysis supported a two-factor structure with good internal consistency (whole scale 0.846, negative subscale 0.882, positive subscale 0.619). The test-retest reliability correlation coefficients for all items were positive, at 0.871, 0.782, and 0.692 for the whole scale, negative subscale and positive subscale, respectively. The ITAS scores differed significantly between participants with PIR and those without in the expected direction, suggesting good discriminant validity. CONCLUSIONS The C-ITAS-HK is a valid tool for measuring and assessing PIR in the Hong Kong primary care diabetes mellitus population.
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Affiliation(s)
- Kam Pui Lee
- Jockey Club School of Public Health and Primary CareThe Chinese University of Hong KongShatinHong Kong
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12
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Or KY, Yip BHK, Lau CH, Chen HH, Chan YW, Lee KP. Peer Education Group Intervention to Reduce Psychological Insulin Resistance: A Pilot Mixed-Method Study in a Chinese Population. Diabetes Ther 2018; 9:113-124. [PMID: 29218568 PMCID: PMC5801233 DOI: 10.1007/s13300-017-0347-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Psychological insulin resistance (PIR) is common among type II diabetes (DM) patients. Although interventions to reduce PIR have been suggested, there is no standardized intervention to reduce PIR. This trial aimed to assess the preliminary effectiveness of a well-structured interventional patient group (for sample size calculation for larger trials), as well as the acceptability and feasibility of this intervention group. METHODS This study used a quasi-experimental, mixed-method approach. Fifty-three patients with DM were recruited to an interventional group that included a general education of DM and insulin, an insulin pen demonstration, and an insulin-using peer sharing session. Each group consisted of around 15 participants and lasted for 2 h each. The validated Chinese version of the insulin treatment appraisal scale (C-ITAS) was administered before, immediately after, and 1 month after the intervention to measure any changes in the participants' PIR. Patients were interviewed to assess the acceptability of the intervention until data saturation. RESULTS Repeated measures ANOVA showed that the post-intervention C-ITAS scores (immediately post group and at 1 month) were lower than the pre-intervention C-ITAS scores (p < 0.001). Changes in multiple attitudes toward insulin were detected before and after the group intervention. Ten patient interviews were conducted and found that the intervention was welcomed by all interviewees; no discomfort or adverse reactions were reported. CONCLUSION Preliminary results showed that patient intervention groups with general education, insulin pen demonstration, and peer sharing appeared to be safe, acceptable, and effective in reducing PIR. Larger multicenter trials are needed to generalize these findings.
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Affiliation(s)
- Ka Yan Or
- Department of Family Medicine, Kowloon Central Cluster, Hospital Authority, East Kowloon General Outpatient Clinic, Hong Kong, China
| | - Benjamin Hoi-Kei Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Hang Lau
- Department of Family Medicine, Kowloon Central Cluster, Hospital Authority, East Kowloon General Outpatient Clinic, Hong Kong, China
| | - Hing Han Chen
- Department of Family Medicine, Kowloon Central Cluster, Hospital Authority, East Kowloon General Outpatient Clinic, Hong Kong, China
| | - Yuk Wah Chan
- Department of Family Medicine, Kowloon Central Cluster, Hospital Authority, East Kowloon General Outpatient Clinic, Hong Kong, China
| | - Kam Pui Lee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Holmes-Truscott E, Furler J, Blackberry I, O'Neal DN, Speight J. Predictors of insulin uptake among adults with type 2 diabetes in the Stepping Up Study. Diabetes Res Clin Pract 2017; 133:204-210. [PMID: 29122108 DOI: 10.1016/j.diabres.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/13/2016] [Accepted: 01/06/2017] [Indexed: 12/31/2022]
Abstract
AIMS We aimed to investigate predictors of insulin uptake, and change in insulin appraisals, among adults with type 2 diabetes mellitus (T2DM) who participated in the Stepping Up trial. METHODS The Stepping Up model of care, supporting timely insulin initiation in primary care, was evaluated in a two-armed cluster-randomised controlled trial. Participants were 266 adults (mean±SD age 62±10years; 39% women) with T2DM (median (IQR) duration 8.5 (5, 13)years) from 74 primary care practices (Stepping Up intervention: 57%, control 43%). At 12months, 47% (n=126) had commenced insulin. Controlling for randomisation, logistic regression was used to explore baseline predictors of insulin uptake, including: demographic and clinical characteristics, emotional wellbeing (depressive symptoms and diabetes-related distress), insulin treatment appraisals, and, 'willingness' to initiate insulin. Two-way analysis of variance examined effects of, and interaction between, randomisation and insulin uptake on 12-month change in insulin appraisals. RESULTS Participants using insulin at 12months were more likely (all p<0.05) than those with non-insulin-treated T2DM to report: lower socioeconomic status, higher baseline HbA1c (median difference: 0.3%; 3mmol/mol), greater willingness to commence insulin (very willing: 27% vs 12%), and less negative and more positive insulin appraisals. All contributed significantly to the final model (χ2(8)=92.1, p<0.001) except insulin appraisals. Regardless of trial allocation, those initiating insulin reported significantly greater reductions in negative insulin appraisals. CONCLUSIONS Controlling for randomisation, 12-month insulin use was predicted by higher baseline HbA1c and 'willingness' to use insulin if recommended. Negative insulin appraisals reduced following insulin initiation.
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Affiliation(s)
- Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia.
| | - John Furler
- Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton 3052, VIC, Australia
| | - Irene Blackberry
- Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton 3052, VIC, Australia; John Richards Initiative, Australian Institute of Primary Care and Ageing, La Trobe University, PO Box 821, Wodonga 3689, VIC, Australia
| | - David N O'Neal
- University of Melbourne, Department of Medicine, St Vincent's Hospital Melbourne, Fitzroy 3065, Australia
| | - Jane Speight
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; AHP Research, 16 Walden Way, Hornchurch RM11 2LB, United Kingdom
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14
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Abstract
PURPOSE OF REVIEW This study aims to examine the operationalisation of 'psychological insulin resistance' (PIR) among people with type 2 diabetes and to identify and critique relevant measures. RECENT FINDINGS PIR has been operationalised as (1) the assessment of attitudes or beliefs about insulin therapy and (2) hypothetical or actual resistance, or unwillingness, to use to insulin. Five validated PIR questionnaires were identified. None was fully comprehensive of all aspects of PIR, and the rigour and reporting of questionnaire development and psychometric validation varied considerably between measures. Assessment of PIR should focus on the identification of negative and positive attitudes towards insulin use. Actual or hypothetical insulin refusal may be better conceptualised as a potential consequence of PIR, as its assessment overlooks the attitudes that may prevent insulin use. This paper provides guidance on the selection of questionnaires for clinical or research purpose and the development of new, or improvement of existing, questionnaires.
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Affiliation(s)
- E Holmes-Truscott
- School of Psychology, Deakin University, Geelong, VIC, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
| | - F Pouwer
- Department of Psychology, University of Southern Denmark, Odense M, Denmark
| | - J Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- AHP Research, Hornchurch, Essex, UK
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Taylor CG, Taylor G, Atherley A, Hambleton I, Unwin N, Adams OP. The Barbados Insulin Matters (BIM) study: Barriers to insulin therapy among a population-based sample of people with type 2 diabetes in the Caribbean island of Barbados. J Clin Transl Endocrinol 2017; 8:49-53. [PMID: 29067259 PMCID: PMC5651331 DOI: 10.1016/j.jcte.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 12/27/2022] Open
Abstract
AIM The purpose of this study was to document in people with type 2 diabetes (T2DM) in Barbados, attitudes and beliefs that may result in psychological insulin resistance. METHODS A representative, population-based, sample of 175 eligible people with T2DM 25 years of age and over was surveyed by telephone. The 20-item insulin treatment appraisal scale (ITAS) was administered (score range 20 to 100 for positive to negative perceptions). RESULTS 117 people participated (67% response rate, 32% male, mean age 66 years, 90% Black, 22% on insulin). Of non-responders, 52 were not contactable and 6 were difficult to communicate with. Negative perceptions about insulin use included - meant a worsening of diabetes (68%), would worry family (63%), feared self-injection (58%), meant a failure in self-management (57%), injections were painful (54%), would be seen as being sicker (46%), increased hypoglycaemia risk (38%), required effort (34%), causes weight gain (27%), causes a deterioration in health (14%), and would have to give up enjoyable activities (10%). Positive perceptions were - helps good glycaemic control (78%), would prevent complications (61%) and improves health (58%). Mean total ITAS score (61.6, SD = 7.7) was lower for those on insulin compared to those not on insulin (53.7 vs. 63.8, p < 0.0001). Sex, age and diabetes diagnosis duration were not significant predictors of ITAS score. CONCLUSIONS Multiple factors related to patient beliefs and attitudes need to be considered and addressed when initiating insulin in order to minimise psychological insulin resistance and delay. Patients using insulin had less negative perceptions than those not on insulin.
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Affiliation(s)
- Charles G. Taylor
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados
| | - Gordon Taylor
- 1 West 5.115, Department for Health, University of Bath, Claverton Down, BA2 7AY, United Kingdom
| | - Anique Atherley
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados
| | - Ian Hambleton
- Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | - Nigel Unwin
- Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | - O. Peter Adams
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados
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Holmes-Truscott E, Browne JL, Speight J. The impact of insulin therapy and attitudes towards insulin intensification among adults with type 2 diabetes: A qualitative study. J Diabetes Complications 2016; 30:1151-7. [PMID: 27114388 DOI: 10.1016/j.jdiacomp.2016.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND As type 2 diabetes (T2DM) is a progressive chronic condition, regular clinical review and treatment intensification are critical for prevention of long-term complications. Our aim was to explore the personal impact of insulin therapy, both positive and negative consequences, and attitudes towards future insulin intensification. METHODS Twenty face-to-face interviews were conducted, and transcripts were analysed using thematic inductive analysis. Eligible participants were adults with T2DM, using insulin injections for <4years. Participants were mostly men (n=13, 65%), (median (range)) aged 65 (43-76) years, living with T2DM for 11.5 (2-27) years. RESULTS Five themes emerged regarding the consequences (positive and negative) of insulin therapy, including: physical impact, personal control, emotional well-being, freedom/flexibility, (concerns about) others' reactions. Increased inconvenience and the perceived seriousness of using fast-acting insulin were both reported as barriers to future insulin intensification, despite most participants being receptive to the idea of administering additional injections. CONCLUSIONS Positive and negative experiences of insulin therapy were reported by adults with T2DM and most were receptive to insulin intensification despite reported barriers. These findings may inform clinical interactions with people with T2DM and interventions to promote receptiveness to insulin initiation and intensification.
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Affiliation(s)
- Elizabeth Holmes-Truscott
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne, 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood, 3125, VIC, Australia.
| | - Jessica L Browne
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne, 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood, 3125, VIC, Australia
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne, 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood, 3125, VIC, Australia; AHP Research, 16 Walden Way, Hornchurch RM11 2LB, United Kingdom
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17
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Holmes-Truscott E, Skinner TC, Pouwer F, Speight J. Explaining psychological insulin resistance in adults with non-insulin-treated type 2 diabetes: The roles of diabetes distress and current medication concerns. Results from Diabetes MILES--Australia. Prim Care Diabetes 2016; 10:75-82. [PMID: 26150327 DOI: 10.1016/j.pcd.2015.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/01/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
AIMS To investigate the contribution of general and diabetes-specific emotional wellbeing and beliefs about medicines in the prediction of insulin therapy appraisals in adults with non-insulin-treated type 2 diabetes. METHODS The sample included Diabetes MILES-Australia cross-sectional survey participants whose primary diabetes treatment was oral hypoglycaemic agents (N=313; 49% women; mean±SD age: 57±9 years; diabetes duration: 7±6 years). They completed validated measures of beliefs about the 'harm' and 'overuse' of medications in general (BMQ General); 'concerns' about and 'necessity' of current diabetes medications (BMQ Specific); negative insulin therapy appraisals (ITAS); depression (PHQ-9); anxiety (GAD-7), and diabetes distress (DDS-17). Factors associated with ITAS Negative scores were examined using hierarchical multiple regressions. RESULTS Twenty-two percent of the variance in ITAS Negative scores (52±10), was explained by: number of complications (β=-.15, p=.005), DDS-17 subscale 'emotional burden' (β=.23, p<.001), and 'concerns' about current diabetes treatment (β=.29, p<.001). General beliefs about medications and general emotional wellbeing did not contribute significantly to the model. CONCLUSIONS Psychological insulin resistance may reflect broader distress about diabetes and concerns about its treatment but not general beliefs about medicines, depression or anxiety. Reducing diabetes distress and current treatment concerns may improve attitudes towards insulin as a potential therapeutic option.
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MESH Headings
- Administration, Oral
- Aged
- Anxiety/epidemiology
- Anxiety/psychology
- Australia/epidemiology
- Cost of Illness
- Cross-Sectional Studies
- Depression/epidemiology
- Depression/psychology
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/psychology
- Emotions
- Female
- Health Care Surveys
- Health Knowledge, Attitudes, Practice
- Humans
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Insulin/administration & dosage
- Insulin/adverse effects
- Insulin Resistance
- Male
- Middle Aged
- Patient Acceptance of Health Care
- Perception
- Risk Assessment
- Risk Factors
- Stress, Psychological/diagnosis
- Stress, Psychological/epidemiology
- Stress, Psychological/psychology
- Surveys and Questionnaires
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Affiliation(s)
- E Holmes-Truscott
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia.
| | - T C Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, 0909 Northern Territory, Australia.
| | - F Pouwer
- Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, postbus 90153, 5000 LE Tilburg, The Netherlands.
| | - J Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia; AHP Research, 16 Walden Way, Hornchurch RM11 2LB, United Kingdom.
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Odawara M, Ishii H, Tajima N, Iwamoto Y. Impact of patient attitudes and beliefs to insulin therapy upon initiation, and their attitudinal changes after initiation: the DAWN Japan study. Curr Med Res Opin 2016; 32:681-6. [PMID: 26743676 DOI: 10.1185/03007995.2015.1136605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective As a part of the Diabetes Attitudes, Wishes and Needs (DAWN) Japan study, a multi-center, questionnaire-based survey conducted between 2004 and 2005, this analysis aimed to (1) explore patients' attitudes and beliefs contributing to their decision to start insulin therapy, and (2) assess the changes in their attitudes and beliefs after actual initiation. Methods Insulin-naive patients with type 2 diabetes who were recommended to start insulin therapy (n = 149) were invited to answer a 21-item questionnaire consisting of five clusters assessing their attitudes and beliefs toward insulin therapy. The questionnaire was administered twice: first upon insulin recommendation, and then 1 month after insulin initiation for those who started and 4 months after for those who did not. Results Of 130 patients included in the analysis, 74 patients (56.9%) started insulin therapy. 'Negative image of injections' and 'Positive image toward insulin therapy' were significantly associated with patient decision to start insulin therapy (odds ratios [95% CI]: 0.49 [0.32-0.76] and 2.58 [1.51-4.42], respectively). After insulin initiation, 'Negative image of injections', 'Positive image toward insulin therapy', 'Feelings of guilt regarding diabetes self-management', and 'Negative image toward insulin therapy' decreased significantly (P < 0.001 for all). 'Social/interpersonal effects' did not change after insulin initiation. Conclusions This study demonstrated that patients who started insulin therapy were less likely to have negative images of injections and more likely to have positive images toward insulin therapy. Starting insulin therapy did not deteriorate the patient's overall impression of therapy. The key limitation is the relatively small sample size (n = 130). The results suggest that education about the benefits of insulin therapy may help patients who are not ready to initiate insulin overcome their barrier to early insulin initiation and practical support may help those who have already started therapy to maintain its use.
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Affiliation(s)
- Masato Odawara
- a Department of Diabetology, Metabolism, and Endocrinology , Tokyo Medical University , Tokyo , Japan
| | - Hitoshi Ishii
- b Department of Diabetology , Nara Medical University , Kashihara , Japan
| | - Naoko Tajima
- c Jikei University School of Medicine , Tokyo , Japan
| | - Yasuhiko Iwamoto
- d The Institute for Adult Diseases, Asahi Life Foundatio n , Tokyo , Japan
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Lee KP. Psycholosocial factors associated with psychological insulin resistance in primary care patients in Hong Kong. J Clin Transl Endocrinol 2015; 2:157-62. [PMID: 29159120 DOI: 10.1016/j.jcte.2015.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 11/22/2022]
Abstract
No relationship was found between depression and PIR. Prevalence of PIR was 47.2% in insulin-naïve patients and 8.7% in insulin users. PIR etiology is likely multifactorial in Hong Kong primary care population. PIR was associated with multiple social factors.
Aim Patients with diabetes mellitus (DM) often delay the initiation of insulin treatment and titration due to psychological factors. This phenomenon is called psychological insulin resistance (PIR). The insulin treatment appraisal scale (ITAS) that was initially developed for Western populations has been translated and validated to measure PIR in Taiwanese populations (C-ITAS). This study aims to estimate the prevalence of PIR in primary care patients with DM in Hong Kong and to examine the relationship between PIR and psychosocial factors. Method 402 DM patients from a government-funded general outpatient clinic completed the C-ITAS and a health questionnaire (the Patient Health Questionnaire-9, PHQ-9). Patient demographics were recorded and associations among C-ITAS scores, PHQ-9 scores and demographic data were evaluated. Results There was no relationship between the presence of depression and PIR. Furthermore, the prevalence of PIR was 47.2% in insulin-naive patients but only 8.7% in current insulin users. Tools such as the C-ITAS may help clinicians understand the etiology of PIR, which this study suggests is likely the result of multiple risk factors. Factors associated with a lower prevalence of PIR included current insulin use, a family history of insulin use, a high education level, male sex, and having received counseling from a physician about insulin within the previous 6 months.
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Bahrmann A, Abel A, Zeyfang A, Petrak F, Kubiak T, Hummel J, Oster P, Bahrmann P. Psychological insulin resistance in geriatric patients with diabetes mellitus. Patient Educ Couns 2014; 94:417-422. [PMID: 24341962 DOI: 10.1016/j.pec.2013.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/29/2013] [Accepted: 11/19/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the extent to which geriatric patients with diabetes mellitus experience psychological insulin resistance (PIR). METHODS A total of 67 unselected geriatric patients with diabetes (mean age 82.8±6.7 years, diabetes duration 12.2 [0.04-47.2] years, 70.1% female) were recruited in a geriatric care center of a university hospital. A comprehensive geriatric assessment (CGA) was performed including WHO-5, Hospital Anxiety and Depression Scale (HADS), Mini Mental State Examination (MMSE) and Barthel-Index. We assessed PIR using the Barriers of Insulin Treatment Questionnaire (BIT) and the Insulin Treatment Appraisal Scale in a face-to-face interview. RESULTS Insulin-naïve patients (INP) showed higher PIR scores than patients already on insulin therapy (BIT-sum score: 4.3±1.4 vs. 3.2±1.0; p<0.001). INP reported in the BIT increased fear of injection and self-testing (2.4±2.4 vs. 1.3±0.8; p=0.016), expect disadvantages from insulin treatment (2.7±1.6 vs. 1.9±1.4; p=0.04), and fear of stigmatization by insulin injection (5.2±2.3 vs. 3.6±2.6; p=0.008). Fear of hypoglycemia, however, did not differ significantly (6.3±2.8 vs. 5.1±3.1; p=0.11). Depression was not shown to be a barrier to insulin therapy. CONCLUSION INP with diabetes have a significantly more negative attitude toward insulin therapy in comparison to patients already on insulin. PRACTICE IMPLICATIONS Systematic assessment of barriers of insulin therapy, individualized diabetes treatment plans and information of patients may help to overcome such negative attitudes, leading to quicker initiation of therapy, improved adherence to treatment and a better quality of life.
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Affiliation(s)
- Anke Bahrmann
- Friedrich-Alexander-University Erlangen-Nürnberg, Department of Internal Medicine 2, Erlangen-Nürnberg, Germany; Robert Bosch Foundation, Stuttgart, Germany; Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Germany.
| | - Amelie Abel
- Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Germany
| | - Andrej Zeyfang
- University of Ulm, Department of Epidemiology, Germany; Bethesda Hospital, Department of Internal Medicine and Geriatrics, Stuttgart, Germany
| | - Frank Petrak
- LWL University Hospital, Ruhr-University Bochum, Department of Psychosomatic Medicine and Psychotherapy, Bochum, Germany
| | - Thomas Kubiak
- University of Mainz, Institute of Psychology, Mainz, Germany
| | - Jana Hummel
- Robert Bosch Foundation, Stuttgart, Germany; Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Germany
| | - Peter Oster
- Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Germany
| | - Philipp Bahrmann
- Robert Bosch Foundation, Stuttgart, Germany; Friedrich-Alexander-University Erlangen-Nürnberg, Institute of Biomedicine for Aging, Nürnberg, Germany.
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