Successful Health Care Provider Strategies to Overcome Psychological Insulin Resistance in United States and Canada

Abstract

Purpose: To identify specific actions and characteristics of health care providers (HCPs) in the United States and Canada that influenced patients with type 2 diabetes who were initially reluctant to begin insulin. Methods: Patients from the United States (n = 120) and Canada (n = 74) were recruited via registry, announcements, and physician referrals to complete a 30-minute online survey based on interviews with patients and providers regarding specific HCP actions that contributed to the decision to begin insulin. Results: The most helpful HCP actions were patient-centered approaches to improve patients' understanding of the injection process (ie, "My HCP walked me through the whole process of exactly how to take insulin" [helped moderately or a lot, United States: 79%; Canada: 83%]) and alleviate concerns ("My HCP encouraged me to contact his/her office immediately if I ran into any problems or had questions after starting insulin" [United States: 76%; Canada: 82%]). Actions that were the least helpful included referrals to other sources (ie, "HCP referred patient to a class to help learn more about insulin" [United States: 40%; Canada: 58%]). Conclusions: The study provides valuable insight that HCPs can use to help patients overcome psychological insulin resistance, which is a critical step in the design of effective intervention protocols.

‘Is insulin right for me?’: Feasibility of a pilot randomised controlled trial and acceptability of a web‐based intervention to reduce psychological barriers to insulin therapy among adults with type 2 diabetes

“…8,9 Although there is growing evidence for effective clinical strategies to support timely insulin initiation (e.g. a collaborative care approach, demonstration of injections), [9][10][11][12] some healthcare professionals report a lack of confidence in providing insulin-specific counselling and raise concerns about the feasibility of implementing interventions to reduce PIR within routine care. 4,13 There is also preliminary evidence for the effectiveness insulinspecific group education programs addressing psychological barriers to insulin.…”

‘Is Insulin Right for Me?’ Development of a theory-informed, web-based resource for reducing psychological barriers to insulin therapy in type 2 diabetes

“…Each of the eight ‘active interventions’ (corresponding with eight identified barriers) uses evidence-based and practical strategies to deliver the BCTs, such as modelling/demonstration, persuasive communication and information provision. The relevant BCTs we selected have been reported elsewhere,13 15 34 35 that is, that HCPs who engage in the identified behaviours are perceived by people with T2D as more helpful, are associated with greater acceptance of insulin and more successful initiation and persistence. Modelling and demonstration of the injection process has been highlighted as particularly important for reducing PIR13 and is consistent with common clinical recommendations 36…”

Many Family Medicine Successful Interventions and Clinical Reviews for Common Illnesses

“…By the next visit, he was giving himself the injections and said, "Well, I never woke up when she gave me the shots and my sugars were better." Tanga et al 6 reported on additional physician strategies that did and did not work to overcome psychological insulin resistance.…”