Diabetes patients put off starting insulin by thought of lifelong therapy
MedWire News: Depression and objection to the idea of lifelong insulin therapy are associated with a strong negative attitude towards starting insulin therapy among Type 2 diabetes patients, report researchers.
General practitioners and practice nurses should be more aware of the possibility that patients may object to lifelong insulin therapy when suggesting they initiate the treatment, says the team.
As reported in the journal Diabetic Medicine, Wilma Scholte op Reimer (Amsterdam University of Applied Sciences, the Netherlands) and colleagues administered self-report questionnaires to 101 insulin-naïve diabetes patients from five general practices in Amsterdam.
All patients were asked whether or not they would be willing to accept insulin treatment if it was suggested to them in the future.
Attitudes towards insulin therapy were examined using the Insulin Treatment Appraisal Scale (ITAS), and depression status was determined using the Center for Epidemiological Studies Depression questionnaire.
Results showed that 39% of the participants would be unwilling to accept insulin therapy if it was recommended to them.
Those unwilling to accept the treatment were more opposed to the idea of lifelong insulin therapy than those who were willing to accept it (92 vs 60%). The unwilling participants also had a higher mean total ITAS score, indicating a more negative appraisal of insulin therapy, than the willing participants (39 vs 35 out of 80).
Of the unwilling participants, 59% perceived insulin initiation as a reflection of their failure to control diabetes with tablets or lifestyle, compared with only 33% of willing participants. They were also more reluctant than the willing participants to take responsibility for managing their diabetes injections correctly each day (49 vs 24%).
Multivariate analysis revealed that depression and objection to lifelong insulin therapy were independently associated with psychological insulin resistance.
And in further analysis, patients' opposition to lifelong insulin therapy significantly correlated with anticipating having to give up pleasant activities, being unable to fulfill responsibilities, and feeling more dependent on their physician.
This showed a sense of limitation of daily life and loss of independence that should not be underestimated, say the authors.
"Emphasis should be placed on the healthy benefits of insulin, as this might facilitate the acceptance of insulin therapy," write Scholte op Reimer et al. "General practitioners and general practice nurses will need to look beyond the initial 'no' to a proposal of insulin therapy," they conclude.
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By Sally Robertson