Diabetes Metab J > Volume 32(3); 2008 > Article
Korean Diabetes Journal 2008;32(3):269-279.
DOI: https://doi.org/10.4093/kdj.2008.32.3.269    Published online June 1, 2008.
A Study on Resistance in Type 2 Diabetic Patient Against Commencement of Insulin Treatment.
Sun Hwa Hong, Mi Jin Kim, Sung Gab Noh, Dae Won Suh, Suk Jung Youn, Kwan Woo Lee, Ho Chae Lee, Yang Soo Chung, Hong Ryang Chung, Hyuk Sang Kwon, Bong Yun Cha, Ho Young Son, Kun Ho Yoon
1Department of Internal Medicine, The Catholic University of Korea, Korea.
2Hong Ik Hospital, Korea.
3Noh Medical Clinic, Korea.
4Suh Medical Clinic, Korea.
5Youn Medical Clinic, Korea.
6Lee Kwan Woo Medical Clinic, Korea.
7Lee Medical Clinic, Korea.
8Hana Medical Clinic, Korea.
9Konyang University Hospital, Korea.
Abstract
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.
Key Words: Attitude of insulin therapy, Psychological insulin resistance, Type 2 diabetes


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