UCSF

Factors Associated with Insulin Reluctance in Individuals with Type 2 Diabetes

by

Soohyun Nam, RN, MSN, ANP

ABSTRACT

Background: There are many barriers to effective diabetes management for people with type 2 diabetes (T2D) and clinicians. Patients' reluctance to start insulin therapy is one of the barriers to effective management that may be influenced by patients' sociodemographic and psychosocial factors. Significant delay in starting insulin may increase complications and impair patients' quality of life. Little is known about insulin reluctance (IR) and its relationship with associated factors.

Purpose: 1) Summarize existing knowledge regarding various barriers to diabetes management from the perspectives of both patients and clinicians; 2) investigate the concept of IR, resistance to using insulin therapy, by describing patients' perceived barriers and their relationships with associated factors; and 3) examine the effectiveness of culturally competent diabetes education (CCDE) among ethnic minorities with T2D.

Methods: The first paper was a literature review regarding various barriers to diabetes management. The second study was a cross-sectional descriptive study. Data were collected from 178 people with T2D, who were 18 years or older, being treated with diabetic oral agents and able to speak English. The participants from general medicine practice clinics completed validated measures: Diabetes Attitude Scale, Diabetes Knowledge Test, Diabetes Self-efficacy Scale, Interpersonal processes of Care and Barriers to Insulin Treatment. Biomedical data were obtained from medical record reviews. The third study was a meta-analysis to evaluate the effectiveness of CCDE for ethnic minorities with T2D.

Findings: The first paper revealed that patients' adherence, attitude, knowledge about diabetes, culture, language capability, financial resources, comorbidity and social support may affect diabetes management. Clinician barriers to following treatment guidelines include beliefs, attitudes and knowledge, patient-clinician interaction and communication, and the health care system. The second study demonstrated that people with T2D had moderate IR. Fear of hypoglycemia was the strongest barrier to insulin treatment. Women were more reluctant to use insulin than men. Ethnic minorities had more psychological barriers to insulin treatment than whites. Greater diabetes self-efficacy scores predicted significantly less IR and better perceived interaction with the clinician may reduce IR. The third study showed that CCDE appears to be effective in improving glycemic control for ethnic minorities.

Word Count: 347