title: Psychological insulin resistance among low-income, U.S. racial minority patients with type 2 diabetes.
abstract: OBJECTIVE
  To examine psychological insulin resistance (PIR), the unwillingness to accept insulin therapy, within a unique U.S. population of patients with diabetes.
  
  
  METHODS
  A cross-sectional survey of PIR among low-income, U.S. Latino and African-American (AA) patients with type 2 diabetes recruited from a diabetes specialty clinic.
  
  
  RESULTS
  Data from 136 insulin-naïve respondents (57% female, 69% Latino, mean age 51.1 ± 10.3 years; $200-$1000 median monthly household income; grade 8-12 median education) revealed a 48% prevalence of complete unwillingness to begin insulin. In comparing Latinos to AA, Latino respondents were younger, lived fewer years in the U.S., had less education, were more likely unwilling to use insulin (53% vs. 30%, p = 0.03), and reported a more negative attitude to 8 of 9 PIR domains (p ≤ 0.01 for each). Fewer years in the U.S. predicted greater unwillingness and a more negative attitude on 8 of 9 PIR domains (p ≤ 0.03 for each); and less education predicted greater feelings of unfairness (p = 0.01).
  
  
  CONCLUSIONS
  PIR is highly prevalent among low income, U.S. Latino patients with type 2 diabetes. Our data may help to better guide culturally appropriate counseling regarding insulin use.
authors.affiliation: Division of Endocrinology, Metabolism & Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
authors.forename: Suman
authors.initials: S
authors.lastname: Machinani
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Bazargan-Hejazi
authors.forename: Stanley H
authors.initials: SH
authors.lastname: Hsia
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007333:Insulin Resistance / Q000208:ethnology*; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology; D010465:Perception; D011203:Poverty / Q000208:ethnology* / Q000523:psychology; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin