Psychological Resistance for Insulin Therapy Among Patients with type 2 Diabetes Mellitus: a Cross Sectional Survey

Introduction: Psychological insulin resistance can result in delays in treatment initiation. The aim of our study is to find the prevalence of psychological insulin resistance among patients at a tertiary hospital in Sri Lanka.

Materials and methods: A prospective cross sectional survey was conducted at General Medical clinic, Colombo North Teaching Hospital, using a pre-tested, intervieweradministered 25 question survey adapted from Insulin Treatment Appraisal Scale (ITAS) among a consequent sample of 358 patients.

Results: Majority (52.2%) of patients considered commencement of insulin therapy as personal failure (P=0.0001). Gender had a significant impact on the fear for needle with females having a higher negative score (3.39) compared to males (3.18) (P=0.040). Overall negative appraisal for insulin was similar in both genders. 49.1% feared that once insulin is started it is needed permanently while 0.8% opposed it. Statistically significant difference was not found between the total mean score for negative items among patients on OHDs (3.19) and patients on insulin (3.10) (P=0.133). Perception of social stigmata and perception of injection conveyed higher negative appraisal. Educational level and duration of diabetes did not have significant influence on insulin perception.

Conclusion: Health care workers need to probe into the perceptions that worry the patients and focus on groups with more negative appraisal towards insulin.