Psychological insulin resistance in Australians with type 2 diabetes already using insulin: Results from Diabetes MILES-Australia — ASN Events
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Psychological insulin resistance in Australians with type 2 diabetes already using insulin: Results from Diabetes MILES-Australia (#95)

Elizabeth Holmes-Truscott 1 2 , Timothy C Skinner 3 , Frans Pouwer 4 , Jane Speight 1 2 5
  1. The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia - Vic, Melbourne, VIC, Australia
  2. Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia
  3. Rural Clinical School, University of Tasmania, Burnie, TAS, Australia
  4. Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
  5. AHP Research, Hornchurch, Essex, UK

Aims: Although, for many people with type 2 diabetes (T2DM), insulin therapy is inevitable for effective management of blood glucose, about a quarter are unwilling to begin insulin therapy. This negative appraisal is known as ‘psychological insulin resistance’ (PIR) but little is known about whether negative attitudes persist once insulin use commences. Our aim was to identify how insulin is perceived among people with T2DM already using insulin and how this relates to clinical and psychosocial outcomes. Methods: Diabetes MILES – Australia 2011 survey participants completed demographic, clinical and psychosocial questions, including validated measures of PIR (ITAS), depression (PHQ-9), anxiety (GAD-7) and diabetes-related distress (PAID). Subgroup analyses were conducted on responses of 275 people with T2DM using insulin: 46% women; mean±SD age: 59±9 years; diabetes duration: 13±8 years; 77% injecting insulin 3 or fewer times per day. Results: The mean±SD ITAS score was 51±7. Positive aspects of insulin use were endorsed by most: insulin helps to prevent complications, improves health and maintains optimal blood glucose levels (BGLs) (77%, 76% and 78% respectively). However, half (52%) believed taking insulin meant that their diabetes had become worse and one third (39%) believed taking insulin meant they have failed to manage their diabetes. Those with greater PIR were younger (56±10 vs 59±9, p=0.016), reported higher HbA1c (8.3±1.8% vs 7.3±1.2%, p=0.003), were less satisfied with recent BGLs (p<0.001) and less likely to take their insulin as recommended (p=0.022). They were more likely to report depressive symptoms, anxiety, and diabetes-related distress (all p<0.001). Conclusions: Negative attitudes persist after insulin commencement. Higher levels of PIR are accompanied by lower general and diabetes-specific emotional wellbeing, higher HbA1c, and sub-optimal insulin-taking behaviours. Insulin use can be demanding, with ongoing hurdles such as diabetes burnout and feelings of failure. Support and education needs to continue beyond the transition to insulin.