Diabetes Care, Vol 20, Issue 3 292-298, Copyright © 1997 by American Diabetes Association

ARTICLES

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

LM Hunt, MA Valenzuela and JA Pugh
Mexican American Medical Treatment Effectiveness Research Center, Department of Medicine, San Antonio, Texas, USA.

OBJECTIVE: This study examines NIDDM patients' attitudes toward insulin injections, the basis of these attitudes, and how they may affect patients' willingness to take insulin. RESEARCH DESIGN AND METHODS: Forty-four low-income Mexican American NIDDM patients were interviewed using open-ended in-depth interviewing techniques. Transcripts were analyzed using techniques of content analysis. Data classification was cross-checked in analysis conferences and through a second researcher coding 50% of the cases, comparing the results, then resolving any discrepancies. RESULTS: Patients' positive attitudes toward insulin focus on its efficacy and efficiency, the avoidance of complications, and feeling better and more energetic. Negative attitudes were much more frequently discussed and include "technical concerns": anxiety about the pain, proper techniques, and general hassles of taking injections; about hypoglycemic symptoms; and about insulin causing serious health problems; and "experimental concerns": sensing that the disease has progressed into a serious phase, that past treatment efforts have failed, and that the patient has not taken proper care. Attitudes were based on personal experience, observation, what others say, and interactions with health care professionals. CONCLUSIONS: Results from the few published reports on NIDDM patients' attitudes about insulin from various cultural settings were consistent with our findings, indicating that these themes may be generally applicable to a wider population. It is recommended that health care providers take care to avoid unwitting promotion of negative attitudes toward insulin and actively elicit and respond to patient attitudes to reduce reluctance to take the medication.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				J. Rosenstock, R. Bergenstal, R. A. DeFronzo, I. B. Hirsch, D. Klonoff, A. H. Boss, D. Kramer, R. Petrucci, W. Yu, B. Levy, et al. Efficacy and Safety of Technosphere Inhaled Insulin Compared With Technosphere Powder Placebo in Insulin-Naive Type 2 Diabetes Suboptimally Controlled With Oral Agents Diabetes Care, November 1, 2008; 31(11): 2177 - 2182. [Abstract] [Full Text] [PDF]

				I. Hartman Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence Clin. Med. Res., September 1, 2008; 6(2): 54 - 67. [Abstract] [Full Text] [PDF]

				M. E. Larkin, V. A. Capasso, C.-L. Chen, E. K. Mahoney, B. Hazard, E. Cagliero, and D. M. Nathan Measuring Psychological Insulin Resistance: Barriers to Insulin Use The Diabetes Educator, May 1, 2008; 34(3): 511 - 517. [Abstract] [Full Text] [PDF]

				S. Harris, J.-F. Yale, E. Dempsey, and H. Gerstein Can family physicians help patients initiate basal insulin therapy successfully?: Randomized trial of patient-titrated insulin glargine compared with standard oral therapy: Lessons for family practice from the Canadian INSIGHT trial Can Fam Physician, April 1, 2008; 54(4): 550 - 558. [Abstract] [Full Text] [PDF]

				M Mishali, Y. Vaknin, H Omer, and A. Heymann Conceptualization and measurement of resistance to treatment: the resistance to treatment questionnaire for people with diabetes Fam. Pract., December 1, 2007; 24(6): 610 - 615. [Abstract] [Full Text] [PDF]

				E. B. Fisher, C. T. Thorpe, B. M. DeVellis, and R. F. DeVellis Healthy Coping, Negative Emotions, and Diabetes Management: A Systematic Review and Appraisal The Diabetes Educator, November 1, 2007; 33(6): 1080 - 1103. [Abstract] [Full Text] [PDF]

				M. Heisler Overview of Peer Support Models to Improve Diabetes Self-Management and Clinical Outcomes Diabetes Spectr, October 1, 2007; 20(4): 214 - 221. [Abstract] [Full Text] [PDF]

				C. W. Spellman Insulin Therapy for Maximal Glycemic Control in Type 2 Diabetes Mellitus J Am Osteopath Assoc, July 1, 2007; 107(7): 260 - 269. [Abstract] [Full Text] [PDF]

				A. I. Vinik and Q. Zhang Adding Insulin Glargine Versus Rosiglitazone: Health-related quality-of-life impact in type 2 diabetes Diabetes Care, April 1, 2007; 30(4): 795 - 800. [Abstract] [Full Text] [PDF]

				J. S. Skyler, L. Jovanovic, S. Klioze, J. Reis, W. Duggan, and for the Inhaled Human Insulin Type 1 Diabetes Stud Two-Year Safety and Efficacy of Inhaled Human Insulin (Exubera) in Adult Patients With Type 1 Diabetes Diabetes Care, March 1, 2007; 30(3): 579 - 585. [Abstract] [Full Text] [PDF]

				G. T. McMahon and R. A. Arky Inhaled Insulin for Diabetes Mellitus N. Engl. J. Med., February 1, 2007; 356(5): 497 - 502. [Full Text] [PDF]

				W. T. Cefalu Point: Pulmonary Inhalation of Insulin: Another "Brick in the Wall" Diabetes Care, February 1, 2007; 30(2): 439 - 441. [Full Text] [PDF]

				{blacktriangledown}Exubera: inhaled insulin for diabetes DTB, January 1, 2007; 45(1): 5 - 8. [Abstract] [Full Text] [PDF]

				C. Carver Insulin Treatment and the Problem of Weight Gain in Type 2 Diabetes The Diabetes Educator, November 1, 2006; 32(6): 910 - 917. [Abstract] [Full Text] [PDF]

				S. Bellary and A. H Barnett Review: Inhaled insulin: overcoming barriers to insulin therapy? The British Journal of Diabetes & Vascular Disease, May 1, 2006; 6(3): 103 - 108. [Abstract] [PDF]

				J. Meece Dispelling Myths and Removing Barriers About Insulin in Type 2 Diabetes The Diabetes Educator, January 1, 2006; 32(1): 9S - 18S. [Full Text] [PDF]

				M. Peyrot, R. R. Rubin, T. Lauritzen, S. E. Skovlund, F. J. Snoek, D. R. Matthews, R. Landgraf, L. Kleinebreil, and on behalf of the International DAWN Advisory Panel Resistance to Insulin Therapy Among Patients and Providers: Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study Diabetes Care, November 1, 2005; 28(11): 2673 - 2679. [Abstract] [Full Text] [PDF]

				W. H. Polonsky, L. Fisher, S. Guzman, L. Villa-Caballero, and S. V. Edelman Psychological Insulin Resistance in Patients With Type 2 Diabetes: The scope of the problem Diabetes Care, October 1, 2005; 28(10): 2543 - 2545. [Full Text] [PDF]

				A. B. Hauber, F. R. Johnson, L. Sauriol, and B. Lescrauwaet Risking Health to Avoid Injections: Preferences of Canadians with type 2 diabetes Diabetes Care, September 1, 2005; 28(9): 2243 - 2245. [Full Text] [PDF]

				S. E. Skovlund, M. Peyrot, and on behalf of the DAWN International Advisory Panel The Diabetes Attitudes, Wishes, and Needs (DAWN) Program: A New Approach to Improving Outcomes of Diabetes Care Diabetes Spectr, July 1, 2005; 18(3): 136 - 142. [Full Text] [PDF]

				P. A. Hollander, L. Blonde, R. Rowe, A. E. Mehta, J. L. Milburn, K. S. Hershon, J.-L. Chiasson, and S. R. Levin Efficacy and Safety of Inhaled Insulin (Exubera) Compared With Subcutaneous Insulin Therapy in Patients With Type 2 Diabetes: Results of a 6-month, randomized, comparative trial Diabetes Care, October 1, 2004; 27(10): 2356 - 2362. [Abstract] [Full Text] [PDF]

				W. H. Polonsky and R. A. Jackson What's So Tough About Taking Insulin? Addressing the Problem of Psychological Insulin Resistance in Type 2 Diabetes Clin. Diabetes, July 1, 2004; 22(3): 147 - 150. [Full Text] [PDF]

				J. Rosenstock, J. C. Cappelleri, B. Bolinder, and R. A. Gerber Patient Satisfaction and Glycemic Control After 1 Year With Inhaled Insulin (Exubera) in Patients With Type 1 or Type 2 Diabetes Diabetes Care, June 1, 2004; 27(6): 1318 - 1323. [Abstract] [Full Text] [PDF]

				M. M. Funnell, D. F. Kruger, and M. Spencer Self-Management Support for Insulin Therapy in Type 2 Diabetes The Diabetes Educator, March 1, 2004; 30(2): 274 - 280. [PDF]

				K. Hermansen, T. Ronnemaa, A. H. Petersen, S. Bellaire, and U. Adamson Intensive Therapy With Inhaled Insulin via the AERx Insulin Diabetes Management System: A 12-week proof-of-concept trial in patients with type 2 diabetes Diabetes Care, January 1, 2004; 27(1): 162 - 167. [Abstract] [Full Text] [PDF]

				S. R. Weiss, S.-L. Cheng, I. A. Kourides, R. A. Gelfand, and W. H. Landschulz Inhaled Insulin Provides Improved Glycemic Control in Patients With Type 2 Diabetes Mellitus Inadequately Controlled With Oral Agents: A Randomized Controlled Trial Arch Intern Med, October 27, 2003; 163(19): 2277 - 2282. [Abstract] [Full Text] [PDF]

				A. Fritsche, M. A. Schweitzer, H.-U. Haring, and the 4001 Study Group* Glimepiride Combined with Morning Insulin Glargine, Bedtime Neutral Protamine Hagedorn Insulin, or Bedtime Insulin Glargine in Patients with Type 2 Diabetes: A Randomized, Controlled Trial Ann Intern Med, June 17, 2003; 138(12): 952 - 959. [Abstract] [Full Text] [PDF]

				P. M. Ironside, M. Scheckel, C. Wessels, M. E. Bailey, S. Powers, and D. K. Seeley Experiencing Chronic Illness: Cocreating New Understandings Qual Health Res, February 1, 2003; 13(2): 171 - 183. [Abstract] [PDF]

				Special Considerations for the Education and Management of Older Adults With Diabetes The Diabetes Educator, January 1, 2003; 29(1): 93 - 96. [PDF]

				E. R. Port, L. L. Montgomery, A. S. Heerdt, and P. I. Borgen Patient Reluctance Toward Tamoxifen Use for Breast Cancer Primary Prevention Ann. Surg. Oncol., August 1, 2001; 8(7): 580 - 585. [Abstract] [Full Text] [PDF]

				F. Aloozer Secondary Analysis of Perceptions and Meanings of Type 2 Diabetes Among Mexican American Women The Diabetes Educator, September 1, 2000; 26(5): 785 - 795. [Abstract] [PDF]

				Special Considerations for the Education and Management of Older Adults With Diabetes The Diabetes Educator, January 1, 2000; 26(1): 37 - 39. [PDF]

				American Association of Diabetes Educators Special Considerations for the Education and Management of Older Adults With Diabetes The Diabetes Educator, November 1, 1999; 25(6): 879 - 881. [PDF]

				L. M. Hunt, N. H. Arar, A. C. Larme, S. H. Rankin, and R. M. Anderson Contrasting Patient and Practitioner Perspectives in Type 2 Diabetes Management West J Nurs Res, December 1, 1998; 20(6): 656 - 682. [Abstract] [PDF]