Type 2 diabetes

Insulin should not be used as a threat: experts


Clinicians should avoid using the threat of insulin therapy to inspire better diabetes management, as this could be contributing to psychological insulin resistance, new research suggests.

The article, published online in Diabetes Research and Clinical Practice, found one quarter of Australians with non-insulin-treated T2DM and suboptimal HbA1c (despite maximal oral therapy) were ‘not at all willing’ to begin insulin therapy if recommended by their GP.

Just one in five was ‘very willing’.

While the majority had at least some positive opinions about the use of insulin, two thirds believe that insulin means their diabetes has become worse, and half interpret insulin use as a personal failure to manage their diabetes effectively.

Co-author Elizabeth Holmes-Truscott, associate research fellow at the Australian Centre for Behavioural Research in Diabetes, told the limbic this was a key issue for all clinicians supporting people with T2DM.

“Feelings of guilt, shame or blame may be common for people with T2DM when treatment intensification is recommended,” she said.

“What’s important about these negative insulin appraisals is that they may be prevented or minimised through early and ongoing education about the progressive nature of the condition and the related treatment intensification over time.”

The study aimed to determine hypothetical willingness to initiate insulin therapy among 261 adults who had been diagnosed with T2DM for at least 10 years.

“The good news story is that half of participants, who would benefit from insulin use, were at least moderately willing to start insulin therapy if recommended by their general practitioner,” said Ms Holmes-Truscott.

However, the study found demographics, clinical factors and emotional wellbeing have little explanatory value, with the overriding issue appearing to be attitudes to insulin therapy.

“It’s not surprising that the strongest predictor of intention to begin insulin was attitudes about insulin therapy,” said Ms Holmes-Truscott.

The study did find some correlation between higher socioeconomic status and receptiveness to insulin.

“There was a general trend towards greater willingness to begin insulin for those living in more socio-economically advantaged areas,” Ms Holmes-Truscott explained.

“It is unclear exactly what the mechanism of this relationship is without further research, for example it could relate to health literacy, health care and education access, or general education level.”

The research emphasises the importance of GPs intervening early to counsel people with T2DM to encourage psychological receptiveness towards insulin.

“Practice which emphasises early education about the natural progression of diabetes and uses of non-judgmental language to discuss diabetes outcomes and treatment possibilities may help to reduce psychological insulin resistance,” she said.

“The threat of insulin therapy should not be used to inspire increased diabetes management behaviours or efforts as this may actually just encourage feelings of personal failure around eventual treatment intensification.”

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