On pens and needles: Treatment strategies for psychological insulin resistance in type 2 diabetes mellitus

Abstract

Background: Psychological insulin resistance (PIR) refers to psychological opposition towards insulin therapy. Although not a formal psychological diagnosis, PIR is an under-recognized issue clinicians may encounter when treating patients with diabetes requiring insulin therapy. Methods: Review articles, clinical trials, and practice guidelines were located using online databases. A total of 39 abstracts were reviewed and 11 articles were included in the analysis. Results: Eleven articles were included. Proposed strategies used to mitigate the occurrence of PIR include: identifying the patient's personal obstacles via administration of PIR questionnaires, use of insulin pens as opposed to conventional syringe and needle, education on the risk of hypoglycemia and continuous emphasis of the importance of self-monitoring of blood glucose (SMBG) readings. Discussion: The management of type 2 diabetes mellitus (T2DM) in patients requiring insulin may present challenges such as PIR. Tailoring a patient's treatment plan to account for physiological, psychological, social and financial needs may thwart some of these challenges. Other factors to consider include the cost of the agent and/or devices required. Insulin-dependent patients with T2DM should be assessed for both physiological and psychological changes. Conclusion: Current treatment strategies for clinicians treating T2DM patients with PIR include administering the PIR or BIT questionnaire, initiating lower doses of insulin, switching from insulin vials to insulin pens, including assessment results in individualized treatment plans and using clinical outcomes to screen patients who are at risk for refusing the use of insulin. Further research evaluating clinical outcomes associated with treatment strategies is necessary.

Peer Education Group Intervention to Reduce Psychological Insulin Resistance: A Pilot Mixed-Method Study in a Chinese Population

“…Despite studies being available on ways to tackle PIR—such as identifying obstacles via administration of PIR questionnaires (e.g., ITAS) [ 10 ], counselling strategies according to patients’ attitude [ 11 ], switching insulin vials to insulin pen and starting at a lower dose of insulin [ 10 ]—PIR remains difficult to tackle and no widely used, recommended, or structured program to tackle it is available. As the Hong Kong Government funded general outpatient clinics (GOPC) have one of the shortest consultation times in the world, which is around 7 min per consultation (and often as short as 2–3 min) [ 12 ], an individual counselling approach may not be feasible.…”