Overcoming psychological barriers in insulin therapy

doi:10.1016/S1557-0843(06)80006-0

Insulin

Volume 1, Issue 1, January 2006, Pages 38-45

https://doi.org/10.1016/S1557-0843(06)80006-0 Get rights and content

Abstract

Background:

Research shows that tight glycemic control is a major factor in forestalling the microvascular and macrovascular complications that accompany diabetes mellitus (DM). Recent evidence shows that earlier use of insulin therapy is beneficial for people who are at higher risk for these complications because it provides more effective glycemic control. Yet, some patients either do not adhere to their insulin therapy or they modify their regimens in an unprescribed way.

Objective:

The goal of this article was to examine the psychological barriers some patients with DM have to insulin therapy. Also discussed are strategies to overcome these barriers.

Methods:

A literature search of MEDLINE was conducted for the period 1992 through 2005, using search word combinations including psychological barriers in people with diabetes, insulin therapy, needle phobia, injection anxiety, weight gain, and fear of hypoglycemia. Relevant articles relating to the topic of overcoming psychological barriers in insulin therapy were studied and summarized.

Results:

The primary reasons why some patients alter their insulin intake are injection-related anxiety, concern about weight gain, and fear of hypoglycemia. Injection-related anxiety, or needle phobia, is associated with higher levels of anxiety, depression, and phobic symptoms; it can result in poor glycemic control. Such patients should be identified early in therapy so that attention can be directed to address this anxiety. Weight gain can become a circuitous problem; the patient may be overweight at the time of DM diagnosis and then fear a weight gain after the initiation of insulin therapy. This may lead to a patient's decision to skip doses of insulin therapy and sacrifice glycemic control in the process. Fear of hypoglycemia can be avoided through awareness of the causes of low blood glucose and prescribing newer insulin analogues that have lesser serum peaks and troughs over a 24-hour period.

Conclusions:

Good communication between patient and clinician is the key in overcoming any psychological barriers to insulin therapy that some patients may have. The optimal use of insulin therapy is dependent on the patient's intentions to use it as prescribed.

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View full text

Overcoming psychological barriers in insulin therapy

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

Diabetes Res Clin Pract

J Psychosom Res

Diabetes Res Clin Pract

Patient Educ Couns

J Am Diet Assoc

Clin Ther

Prim Care

J Diabetes Complications

Diabetes Metab

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus

N Engl J Med

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

Lancet

Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy

Arch Intern Med

Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: Progressive requirement for multiple therapies (UKPDS 49)

JAMA

Eating habits, body weight, and insulin misuse. A longitudinal study of teenagers and young adults with type 1 diabetes

Diabetes Care

Phobia of self-injecting and self testing in insulin-treated diabetes patients: Opportunities for screening

Diabet Med

Phobic symptoms, particularly the fear of blood and injury, are associated with poor glycemic control in type I diabetic adults

Diabetes Care

Psychiatric illness in diabetes mellitus. Relationship to symptoms and glucose control

J Nerv Ment Dis

History of depression increases risk of type 2 diabetes in younger adults

Diabetes Care

NIDDM patients' fears and hopes about insulin therapy. The basis of patient reluctance

Diabetes Care

Use of inhaled insulin in a basal/bolus insulin regimen in type 1 diabetic subjects: A 6-month, randomized, comparative trial

Diabetes Care