Early discussion about the possible use of insulin may help to overcome later ‘psychological insulin resistance’ in patients with type 2 diabetes, new Australian research suggests.
“Our study shows that the majority of adults with type 2 diabetes are aware of the benefits of insulin therapy and the necessity of their diabetes medications,” says lead researcher Liz Holmes-Truscott, from the Australian Centre for Behavioural Research in Diabetes.
“However, they also report negative attitudes and expectations about insulin treatment. Those with more negative attitudes are also more likely to report diabetes distress and concerns about their diabetes medications.”
Ms Holmes-Truscott and her colleagues analysed data from 313 adults with type 2 diabetes using only oral hypoglycaemic medications who completed the Diabetes-MILES Australia survey, and published the outcomes in Primary Care Diabetes.
Questionnaires assessed their beliefs about medications in general, the necessity of their existing diabetes medications and their views about insulin. They also checked for symptoms of depression and anxiety, and levels of diabetes-associated distress.
High scores for the emotional burden of diabetes and concerns about current medications were the strongest predictors of negative views about insulin, but a higher number of diabetes complications was associated with more positive attitudes. General beliefs about medications and general emotional well-being had no effect.
“Our results highlight the need to discuss concerns about, and barriers to, diabetes management for people with type 2 diabetes, not just the medical benefits of intensifying treatment,” Ms Holmes-Truscott said.
The three top negative beliefs in the MILES study were that taking insulin ‘means my diabetes has become much worse’, ‘makes life less flexible’, and ‘means I have failed to manage my diabetes with diet and tablets’.
“We recommend that health professionals and people with type 2 diabetes have conversations about the progressive nature of diabetes, and the possibility of going on to insulin, at an early stage in diagnosis,” she said.
“Health professionals may help ease negative expectations by identifying and exploring barriers of insulin initiation, for example by exploring different insulin administration devices for those with concerns about needles.”
Earlier research had suggested that about one-quarter of people with type 2 diabetes not yet using insulin had refused, or were unwilling to begin, insulin treatment.
In Australia, 23% of those with diagnosed type 2 diabetes are thought to be using insulin even though the median HbA1c of patients overall is 8.0% (64 mmol/mol), reflecting suboptimal glycaemic control.