Psychological Insulin Resistance in Patients With Type 2 Diabetes
The scope of the problem
- William H. Polonsky, PHD, CDE12,
- Lawrence Fisher, PHD3,
- Susan Guzman, PHD2,
- Leonel Villa-Caballero, MD4 and
- Steven V. Edelman, MD56
- 1Department of Psychiatry, University of California, San Diego, San Diego, California
- 2Behavioral Diabetes Institute, San Diego, California
- 3Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
- 4Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California
- 5Division of Endocrinology and Metabolism, University of California, San Diego, San Diego, California
- 6Veterans Affairs Medical Center, San Diego, California
- Address correspondence and reprint requests to William H. Polonsky, PhD, CDE, P.O. Box 2148, Del Mar, CA 92014. Email: whp{at}behavioraldiabetes.org
To achieve tight glycemic control in type 2 diabetic patients, it may be advantageous to introduce insulin therapy much earlier in the disease course (1). Unfortunately, many patients are reluctant to begin insulin and may delay starting insulin therapy for significant periods of time (2,3). Recent evidence suggests that more than one-quarter of patients may refuse insulin therapy once it is prescribed (4). Little is actually known about this phenomenon, often termed “psychological insulin resistance” (PIR), how common it may be, or why patients feel this way. Therefore, we developed and distributed a PIR self-report survey to a large multicity sample of patients with type 2 diabetes who were not taking insulin. The survey examined their willingness to take insulin if it was prescribed and to identify perceived attitudinal barriers to insulin therapy.
RESEARCH DESIGN AND METHODS
Participants at several 1-day conferences for people with diabetes (Taking Control of Your Diabetes) conducted in San Diego, California; Raleigh, North Carolina; Portland, Oregon; Minneapolis, Minnesota; Philadelphia, Pennsylvania; and Honolulu and Hilo, Hawaii completed an anonymous one-page survey concerning insulin attitudes. At the beginning of each conference, an announcement to all participants explained the study, directed them to the questionnaire in their conference syllabus, and asked them to return completed surveys before the conference’s conclusion. The study was approved by the Committee on Human Research at the University of California, San Francisco.
An initial questionnaire item assessed willingness to begin insulin therapy, rated from very willing to not unwilling. Patients also rated on a six-point …
