title: Acceptance of insulin therapy: a long shot? Psychological insulin resistance in primary care.
abstract: OBJECTIVE
  To explore which factors are associated with psychological insulin resistance in insulin-naive patients with Type 2 diabetes in primary care.
  
  
  METHODS
  A sample of 101 insulin-naive patients with Type 2 diabetes completed self-administered questionnaires including demographic and clinical characteristics, the Insulin Treatment Appraisal Scale and the Center for Epidemiological Studies Depression scale. Psychological insulin resistance was denoted by negative appraisal of insulin (Insulin Treatment Appraisal Scale).
  
  
  RESULTS
  Thirty-nine per cent of the sample were unwilling to accept insulin therapy. Unwilling participants perceived taking insulin more often as a failure to control their diabetes with tablets or lifestyle compared with willing participants (59 vs. 33%), unwilling participants were more reluctant to accept the responsibilities of everyday management of insulin therapy (49 vs. 24%). Multiple linear regression analysis revealed that depression and objection to lifelong insulin therapy were independently associated with psychological insulin resistance.
  
  
  CONCLUSIONS
  In this study in primary care, depression and objection to lifelong insulin therapy are associated with psychological insulin resistance. Analysis of the objection to the indefiniteness of insulin therapy showed a sense of limitation of daily life and loss of independence that should not be underestimated. Insulin should be offered as a means to improve health as this might facilitate the acceptance of insulin therapy.
authors.affiliation: Medisch Centrum Oost, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Y J C
authors.initials: YJ
authors.lastname: Woudenberg
authors.forename: C
authors.initials: C
authors.lastname: Lucas
authors.forename: C
authors.initials: C
authors.lastname: Latour
authors.forename: W J M
authors.initials: WJ
authors.lastname: Scholte op Reimer
mesh_terms: D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007333:Insulin Resistance; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human