title: Explaining psychological insulin resistance in adults with non-insulin-treated type 2 diabetes: The roles of diabetes distress and current medication concerns. Results from Diabetes MILES--Australia.
abstract: OBJECTIVE
  To investigate the contribution of general and diabetes-specific emotional wellbeing and beliefs about medicines in the prediction of insulin therapy appraisals in adults with non-insulin-treated type 2 diabetes.
  
  
  METHODS
  The sample included Diabetes MILES-Australia cross-sectional survey participants whose primary diabetes treatment was oral hypoglycaemic agents (N=313; 49% women; mean±SD age: 57±9 years; diabetes duration: 7±6 years). They completed validated measures of beliefs about the 'harm' and 'overuse' of medications in general (BMQ General); 'concerns' about and 'necessity' of current diabetes medications (BMQ Specific); negative insulin therapy appraisals (ITAS); depression (PHQ-9); anxiety (GAD-7), and diabetes distress (DDS-17). Factors associated with ITAS Negative scores were examined using hierarchical multiple regressions.
  
  
  RESULTS
  Twenty-two percent of the variance in ITAS Negative scores (52±10), was explained by: number of complications (β=-.15, p=.005), DDS-17 subscale 'emotional burden' (β=.23, p<.001), and 'concerns' about current diabetes treatment (β=.29, p<.001). General beliefs about medications and general emotional wellbeing did not contribute significantly to the model.
  
  
  CONCLUSIONS
  Psychological insulin resistance may reflect broader distress about diabetes and concerns about its treatment but not general beliefs about medicines, depression or anxiety. Reducing diabetes distress and current treatment concerns may improve attitudes towards insulin as a potential therapeutic option.
authors.affiliation: The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia. Electronic address: etruscott@acbrd.org.au.
authors.forename: E
authors.initials: E
authors.lastname: Holmes-Truscott
authors.affiliation: School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, 0909 Northern Territory, Australia. Electronic address: timothy.skinner@cdu.edu.au.
authors.forename: T C
authors.initials: TC
authors.lastname: Skinner
authors.affiliation: Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, postbus 90153, 5000 LE Tilburg, The Netherlands. Electronic address: F.Pouwer@uvt.nl.
authors.forename: F
authors.initials: F
authors.lastname: Pouwer
authors.affiliation: The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia; AHP Research, 16 Walden Way, Hornchurch RM11 2LB, United Kingdom. Electronic address: jspeight@acbrd.org.au.
authors.forename: J
authors.initials: J
authors.lastname: Speight
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D004644:Emotions; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010465:Perception; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Beliefs about medications; Diabetes distress; Psychological insulin resistance; Type 2 diabetes