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Aims: The aim of this study was to evaluate the perceptions of general physicians (GPs) regarding insulin and determine the barriers to its initiation in patients with type 2 diabetes mellitus (T2DM).Study Design:A cross-sectional, quantitative research.Place and Duration:Enugu metropolis, Southeast Nigeria, between March and November 2018.Methodology:We used structured self administered questionnaire to evaluate the perceptions of 64 GPs (45 males and 19 females) regarding insulin, and to elicit barriers to insulin initiation in subjects with T2DM.Results:The mean (SD) age of the participants was 45.5 (11.7) years and their duration of general practice ranged from 3 –38 years. Majority were private practitioners predominantly in the rural areas. Only 15 (23.4%) respondents had ever initiated insulin for outpatient with T2DM Fear of hypoglycemia, anticipated patients’ refusal of insulin, physician’s lack of confidence, and concerns about needle pains were among the commonly reported barriers to insulin initiation. Others were socio-economic factors including concerns about affordability of insulin and frequent glycemic monitoring, and availability of insulin storage facilities.There was a general consensus among the GPs on a number of misconceptions including that patients’ adherence to oral glucose lowering drugs eliminates the need for insulin; that insulin should be reserved as a last resort; and that once initiated, insulin therapy is lifelong.Conclusion:This study revealed that there are several physician-related barriers and misconceptions regarding insulin therapy for T2DM among GPs in Southeast Nigeria. Periodic training to improve GPs’ attitude to insulin and optimize insulin utilization in T2DM is required
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Objective To explore the effectiveness of insulin dialogue toolkit on psychological insulin resistance of type 2 diabetes. Methods A total of 134 type 2 diabetes with psychological insulin resistance were selected by the inclusion and exclusion criteria . The participates were randomly assigned to control group and intervention group by computer with 67 cases each. The control group was given conventional health education, the intervention group was given insulin dialogue toolkit instead of individual health education based on conventional health education. The intervention was lasted 2 weeks.The total score and each dimension score of my opinion of insulin and the blood glucose before and after intervention were observed. Results Before intervention, the total score in my opinion of insulin in intervention group and control group was (66.40±8.51), (66.91±7.27) scores, and there was no significant difference between two groups, P>0.05.After intervention, the total score in my opinion of insulin in intervention group and control group was(76.93±5.31), (71.09±7.77) scores, and there was significant difference between two groups, Z=-5.585, P0.05. Conclusions The insulin dialogue toolkit has an impact on psychological insulin resistance of type 2 diabetes. Insulin dialogue toolkit is a way to improve the diabetes′attitude of insulin, but the effect on blood sugar are not clarity.
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Objective To explore the status and influencing factor of psychological insulin resis tance (PIR) of type 2 diabetes.Methods 137 in-patients with type 2 diabetes were investigated by selfdesigned questionnaire to get general data and Insulin Perceptions Questionnaire to get PIR data.Multiple linear regression were used to find influencing factor.Results 134 participates had PIR among the 137 in-patients.The older of age,using insulin for longer time and receiving insulin treatment positively had the higher scores of main questionnaire,then had less serious psychological insulin resistance.The duration of illness course,complications,work and using insulin for the first time or not had no relationship with their PIR.Conclusions The findings indicated that the type 2 diabetes using insulin have psychological in sulin resistance generally.Age,the time using insulin,accepting or receiving insulin positively are the independent factors of psychological insulin resistance
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BACKGROUND: To achieve tight glycemic control in the poorly controlled type 2 diabetic patients with oral hypoglycemic agent, it maybe beneficial to initiate insulin treatment at the early stage. Many patients with type 2 diabetes are often reluctant to begin insulin therapy despite poor glycemic control with oral hypoglycemic agents, this little known phenomenon, often termed 'psychological insulin resistance (PIR)'. This study investigates psychological insulin resistance in Korean patients with type 2 diabetes. METHOD: This study examined a total of 76 type 2 diabetic patients with poor glycemic control during period of April to July 2006. Through questionnaire and telephone survey, total 24 questions were asked about various attitudes on insulin therapy including psychological barriers and patients' acceptance of this treatment. Subjects were asked to allocate points in 5-point scale (from 5 points for 'very true' to 1 point for 'very untrue'). RESULTS: The means of psychological rejection, injection-related anxiety and fear of insulin side effects such as hypoglycemia and weight gain were 3.65 +/- 0.92, 3.17 +/- 0.98 and 2.8 +/- 1.02, respectively. Unwillingness was common in insulin therapy, 67% of patient rejected or was unwilling to take insulin. Main reasons of patients most frequently endorsed beginning insulin indicate that disease is worsening, permanence (once you start insulin you can never quit) and sense of personal failure. Furthermore, study indicates that patients' reasons for avoiding insulin therapy were mainly psychological rejection, which extended far beyond a simple injection related anxiety. CONCLUSION: PIR was psychological reluctance rather than injection related anxiety. To overcome these psychological barriers to insulin treatment, it is necessary to address appropriate diabetes education including training and counseling with excellent interactive communications between patients and clinicians.