title: Psychological insulin resistance in geriatric patients with diabetes mellitus.
abstract: OBJECTIVE
  To determine the extent to which geriatric patients with diabetes mellitus experience psychological insulin resistance (PIR).
  
  
  METHODS
  A total of 67 unselected geriatric patients with diabetes (mean age 82.8±6.7 years, diabetes duration 12.2 [0.04-47.2] years, 70.1% female) were recruited in a geriatric care center of a university hospital. A comprehensive geriatric assessment (CGA) was performed including WHO-5, Hospital Anxiety and Depression Scale (HADS), Mini Mental State Examination (MMSE) and Barthel-Index. We assessed PIR using the Barriers of Insulin Treatment Questionnaire (BIT) and the Insulin Treatment Appraisal Scale in a face-to-face interview.
  
  
  RESULTS
  Insulin-naïve patients (INP) showed higher PIR scores than patients already on insulin therapy (BIT-sum score: 4.3±1.4 vs. 3.2±1.0; p<0.001). INP reported in the BIT increased fear of injection and self-testing (2.4±2.4 vs. 1.3±0.8; p=0.016), expect disadvantages from insulin treatment (2.7±1.6 vs. 1.9±1.4; p=0.04), and fear of stigmatization by insulin injection (5.2±2.3 vs. 3.6±2.6; p=0.008). Fear of hypoglycemia, however, did not differ significantly (6.3±2.8 vs. 5.1±3.1; p=0.11). Depression was not shown to be a barrier to insulin therapy.
  
  
  CONCLUSIONS
  INP with diabetes have a significantly more negative attitude toward insulin therapy in comparison to patients already on insulin.
  
  
  CONCLUSIONS
  Systematic assessment of barriers of insulin therapy, individualized diabetes treatment plans and information of patients may help to overcome such negative attitudes, leading to quicker initiation of therapy, improved adherence to treatment and a better quality of life.
authors.affiliation: Friedrich-Alexander-University Erlangen-Nürnberg, Department of Internal Medicine 2, Erlangen-Nürnberg, Germany; Robert Bosch Foundation, Stuttgart, Germany; Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Germany. Electronic address: anke.bahrmann@uk-erlangen.de.
authors.forename: Anke
authors.initials: A
authors.lastname: Bahrmann
authors.affiliation: Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Germany.
authors.forename: Amelie
authors.initials: A
authors.lastname: Abel
authors.affiliation: University of Ulm, Department of Epidemiology, Germany; Bethesda Hospital, Department of Internal Medicine and Geriatrics, Stuttgart, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Zeyfang
authors.affiliation: LWL University Hospital, Ruhr-University Bochum, Department of Psychosomatic Medicine and Psychotherapy, Bochum, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Petrak
authors.affiliation: University of Mainz, Institute of Psychology, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kubiak
authors.affiliation: Robert Bosch Foundation, Stuttgart, Germany; Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Hummel
authors.affiliation: Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Oster
authors.affiliation: Robert Bosch Foundation, Stuttgart, Germany; Friedrich-Alexander-University Erlangen-Nürnberg, Institute of Biomedicine for Aging, Nürnberg, Germany. Electronic address: philipp.bahrmann@iba.fau.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Bahrmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology; D003866:Depressive Disorder / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology*; D005239:Fear; D005260:Female; D015577:Geriatric Assessment; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007279:Injections, Subcutaneous / Q000523:psychology*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007333:Insulin Resistance; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Depression; Diabetes; Fear of injection; Insulin; Psychological insulin resistance