Background: The psychological barriers to initiation and persistence with insulin therapy also referred to as Psychological Insulin resistance (PIR), interferes with use of insulin in patients with diabetes. However, ultimate use of insulin in majority of patients with type 2 diabetes is inevitable over time yet many of the patients still resist it because of PIR. The magnitude of PIR among type 2 diabetics is not known in many clinical practice settings, including Kenya. Patients and methods: This was a cross-sectional survey of PIR in subjects with type 2 diabetes at the Kenyatta National Hospital (KNH), which is a tertiary care and teaching hospital in Kenya, a developing country. Subjects were recruited from the Diabetes Outpatient Clinic where we obtained their socio-demographic and clinical data. We used Insulin Treatment Appraisal Scale (ITAS), which is a validated tool and a structured questionnaire, to collect information regarding psychological insulin resistance. Results: A total of 167 patients with type 2 diabetes were enrolled, where the females were 59.3%. The prevalence of Psychological Insulin Resistance was 82.6% and the mean ITAS score was 52.7. The gender, age, family history of diabetes, duration of diabetes of the patients and their duration of insulin therapy and ability to purchase medication had no significant influence on the positive and/or negative attitudes towards insulin therapy, (p>0.05). Patients who were using insulin had lower mean ITAS score 50.9, than the non-insulin users, ITAS score 59, which reflected lesser negative attitudes in the insulintreated group (p<0.05). The mean (SD) age was 55.5 (13.8) years and the mean (SD) duration of diabetes was 10.2 (8.7) years. Fifty four (32.3%) were on insulin-only treatment, 71 (42.5%) were on combination insulin and oral hypoglycemic agents and 42 (25.1%) were on oral hypoglycemic agents-only therapy. Conclusion: The prevalence of psychological insulin resistance (PIR) among the study patients was quite high at 82.6%. Patients who were already using insulin therapy showed less psychological resistance than the non-insulin user patients which implied a relative acceptance of insulin therapy in the patients who were already using it. Thus, PIR should be deliberately addressed as a unique condition in type 2 diabetes, recognizing from published work that there may be co-morbid depression in insulin users. Counseling patients with type 2 diabetes regarding insulin use should focus on, among many other issues, the perceptual domains of negative attitudes exhibited by a high proportion of them, because these negative attitudes towards insulin therapy can be mitigated. However, we recommend further studies to determine how PIR affects self-care and consequent metabolic control.
Asif H Gulam, Frederick CF Otieno and G Omondi-Oyoo
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