• Insulin
• Diabetes & Endocrinology Clinical Trials
• Nursing Diabetes & Metabolic Syndrome
• Diabetes Mellitus

• Insulin
• Diabetes & Endocrinology Clinical Trials
• Nursing
• Endocrinology
• Diabetes & Metabolic Syndrome
• Diabetes Mellitus

Robert Powell, MS, University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania, USA, presented results from a study involving patient-centered focus groups demonstrating that the phenomenon of patient psychological insulin resistance (PIR) persists in patients with type 2 diabetes mellitus (T2DM). He also discussed how patients' acceptance of therapies was affected by education about insulin and devices and the cost of the therapy.

According to Powell, although insulin therapy is an important treatment option in patients with T2DM, they often view it in negative terms. This negative perception affects the acceptance of insulin therapy, contributes to PIR, and results in low adherence rates. This can further result in clinical inertia, since providers are reluctant to prescribe insulin for patients who will not use it.

Numerous educational resources are available to guide educators as they instruct patients, yet patients are still often unaware of the available educational resources on insulin therapy and how improving their knowledge can improve their health. With this in mind, Powell conducted focus groups to explore perceptions and reactions to insulin therapy delivery modes among insulin-naive and insulin-experienced patients with T2DM.

Powell recruited adults with T2DM (≥ 18 years; n = 96; insulin-naive patients, n = 49). Twelve focus groups were stratified by insulin status (insulin-naive groups, n = 6), limiting in each group to 10 participants. Focus groups led by certified diabetes educators centered on topics including insulin therapies, acceptance and willingness to take insulin, and barriers to initiation and adherence of insulin therapy. Formal qualitative data analysis confirmed that PIR continues to exist in both insulin-naive and insulin-experienced patients with T2DM. PIR and educational needs were similar in both insulin groups and across races and ethnicities.

Resistance to taking insulin was frequently related to specific health concerns. Most participants viewed insulin therapy in negative terms and considered the need to use it as a personal failure. Many patients also expressed concerns about side effects and questioned the need for its long-term use. Patients favored shorter needles and preferred pens versus vials and syringes. However, regardless of the tool, cost was the main barrier for device selection and for acceptance of insulin therapy.

Another theme associated with PIR was related to educational resources. Many participants reported having received no demonstration on how, where, and when to inject their insulin. They expressed the importance of learning injection logistics to overcome injection-associated concerns and improve adherence, and those who had received education on injection techniques expressed satisfaction with their health care team.

Powell conducted an additional focus group with health care providers to examine their barriers. Approximately half of the primary care physicians had questions about how to use and store insulin pens, and many were unaware of needle options. Many reported having insufficient time to provide patients with proper diabetes education.

Powell concluded that this study highlights an opportunity for diabetes educators to empower patients to take insulin effectively. Diabetes educators in particular can reduce patients' apprehension toward insulin therapy through demonstrations of the options for insulin administration and through discussions of the potential risks and benefits.

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