title: Psychological Insulin Resistance in Patients with Type 2 Diabetes.
abstract: OBJECTIVE
  To identify risk factors associated with psychological insulin resistance (PIR) in Indian type 2 diabetes (T2DM) population.
  
  
  METHODS
  Patients with T2DM, aged 18 years, undergoing treatment with oral hypoglycaemic agents and providing written informed consent were considered eligible for the study. Patient's data was collected by face-to-face interaction using 5 validated diabetes questionnaires--Diabetes Attitude Scale, Diabetes Knowledge Test, Diabetes Self-Efficacy Scale, Interpersonal Processes of Care Survey-29, and Barriers to Insulin Treatment scale. Demographic variables, categories of patients based on their annual family income, education, glycosylated haemoglobin (HbA1c), occupation and type of healthcare setup were correlated with overall scores of validated questionnaires. Statistical analyses were performed using Pearson correlation coefficients, analysis of variance, two-group t-test and hierarchical multiple regression.
  
  
  RESULTS
  One hundred ninty-eight patients with T2DM were enrolled where 63% were males, 52% had HbA1c <7% (<53 mmol/mol), 32% were in service, 35% had the annual family income between Rs 100,000-500,000, 50% were graduates and 81% were enrolled from private healthcare set ups. Significant high opposition to use insulin was observed in females, patients based at home, patients with insufficient education, and patients visiting government set-ups compared to males, service-class patients, graduates, and patients approaching private set-ups, respectively.
  
  
  CONCLUSIONS
  In India, major factors contributing to PIR were fear of injection or fear of pain during injection, fear of hypoglycemia, social stigma and lack of education. Effective interpersonal interactions with healthcare providers could help to counteract PIR, especially in patients who are not sufficiently literate highlighting the need of skilled healthcare staffs in Indian public hospitals.
authors.forename: Sujeet
authors.initials: S
authors.lastname: Jha
authors.forename: Manju
authors.initials: M
authors.lastname: Panda
authors.forename: Surya
authors.initials: S
authors.lastname: Kumar
authors.forename: Rekha
authors.initials: R
authors.lastname: Gupta
authors.forename: Archana
authors.initials: A
authors.lastname: Neemani
authors.forename: Jenu
authors.initials: J
authors.lastname: Jacob
authors.forename: Nisha M
authors.initials: NM
authors.lastname: Thomas
authors.forename: Archana
authors.initials: A
authors.lastname: James
authors.forename: Swati
authors.initials: S
authors.lastname: Waghdhare
authors.forename: Gunjan
authors.initials: G
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007194:India; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin