The prevalence of insulin refusal and psychological insulin resistance among Korean patients with type 2 diabetes mellitus

Abstract

Background: This study investigated the prevalence of insulin refusal and compared the level of psychological insulin resistance (PIR) with the intention to accept insulin therapy among Korean patients with type 2 diabetes.Methods: Type 2 diabetes patients (n=1,209) were recruited from inner city outpatient diabetes clinics in 2016. Patient demographic, insulin recommendation, diabetes treatment type, intention to receive insulin therapy, and PIR information was collected using self-reports. The patients were divided into three groups: those who refused insulin therapy (n=184), those who accepted insulin therapy (n=331), and those not recommended for insulin therapy (n=694). Descriptive statistics were used to calculate the prevalence of insulin refusal; t-tests and analyses of variance were used to compare demographics with PIR.Results: The insulin refusal rate was 35.7%. The duration of diabetes, numbers of diabetes-related complications, and glycated hemoglobin levels were significantly lower in the group not recommended for insulin therapy than refused and accepted insulin groups. The level of PIR in insulin refusal group was significantly lower among patients agreeing to receive insulin therapy within 3 months than among those refusing insulin therapy. Conclusions:The prevalence of insulin refusal in Korea is not low, and people who refuse insulin therapy have high levels of PIR. Strategies to reduce PIR levels are needed.

Psychological insulin resistance among type 2 diabetic patients attending primary healthcare centers, Al-Ahsa, Saudi Arabia

“…The prevalence of PIR in males was higher than in females in our study, but the difference was not statistically significant. Moreover, another Korean study[ 23 ] found significantly higher prevalence of insulin refusal in males compared to females, results which are similar to our study results. However, the reverse is true in the American study in which females were more unwilling for insulin than males.…”

“…One-third of the participants in our study expressed their unwillingness to use insulin. Globally, in similar studies done in the USA,[ 20 ] Netherland[ 21 ] Kenya[ 22 ] and Korea[ 23 ] the prevalence of PIR have been found to be from 30% to 83%. However, a study done on the Bangladeshi population in East London found a comparatively lower level of refusal for insulin injection among the type 2 diabetic patients.…”

“…In the same study, patients diagnosed with diabetes <10 years previously had an increased chance of insulin refusal by more than two-fold. In a Korean study,[ 23 ] the researchers found that insulin refusal was more among diabetic patients of less duration than those of more duration. [ 23 ] However, one Saudi[ 17 ] as well as one Libyan study[ 26 ] found that there were no significant associations between unwillingness to start insulin with the duration of diabetes.…”

“…In a Korean study,[ 23 ] the researchers found that insulin refusal was more among diabetic patients of less duration than those of more duration. [ 23 ] However, one Saudi[ 17 ] as well as one Libyan study[ 26 ] found that there were no significant associations between unwillingness to start insulin with the duration of diabetes. The most pronounced negative attitudes of the participants in our study which led to the PIR were: hearing that some people had had a bad experience with insulin, fear of dependence due to regular injections, lack of time for regular doses of insulin, and inability to pay close attention to diet as insulin treatment requires.…”

Effects of an actual insulin injection demonstration on insulin acceptance among patients with T2DM: a pragmatic randomized controlled trial

“…Insulin injection refusal or psychological insulin resistance is a challenge when initiating insulin therapy. The prevalence of insulin injection refusal is diverse in different settings, ranging from 33% to 74% of patients [19][20][21][22][23]. A systematic review of 25 research articles indicated the barriers to insulin injection initiation, including patient-related factors, healthcare professional factors, and system factors [24].…”