Psychological insulin resistance among type 2 diabetes patients at Kenyatta National Hospital

Abstract

Background: Type 2 diabetes is progressive and over years the beta cell mass depletes leading to a lack of insulin which is key in glucose homeostasis. This necessitates the introduction of insulin as part of the patient treatment regime in order to realize optimal glycemic control. The initiation and use of Insulin is however marred by Psychological Insulin resistance (PIR) defined as the psychological barriers to initiation and persistence with insulin therapy amongst type 2 Diabetics. The prevalence of PIR among type 2 diabetics is unknown in Kenya. Objective: To determine the prevalence of Psychological Insulin resistance (PIR) among type 2 diabetics attending the Diabetes Clinic at Kenyatta National Hospital (KNH) using the Insulin treatment Appraisal Scale (ITAS) and to correlate PIR with the demographic and clinical factors. Design: Cross-sectional descriptive survey. Setting: Diabetes Outpatient Clinic at KNH. Subjects: A sample size of 167 type 2 diabetics was selected once the inclusion and exclusion criteria were met. Methods: Insulin Treatment Appraisal Scale (ITAS) and a structured questionnaire were used to collect data and were investigator administered. ITAS is a validated tool used to assess the negative and positive attitudes towards insulin therapy on a Likert scale. The ITAS scores were calculated for each subject with scores of less than 40 representing positive attitudes and scores of above 40 representing negative attitudes. Associations were drawn between the attitudes and the demographic/clinical factors. Logistic regression analysis was done to determine the factors independently associated with negative / positive attitudes towards insulin therapy. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 17.0. Results: One Hundred and Sixty Seven type 2 diabetes patients were studied, 68 males and 99 females with mean age of 55.5 years. Their mean duration of diabetes was found to be 10.2 years. Majority of the patients (55.6%) studied ranged in the 50-69 years age bracket. Positive family history was found in 68 (40.7%) patients. Of the 167 patients; 54(32.3%) were on insulin alone, 42 (25.1%) were on oral hypoglycemic agents and 71 (42.5%) were on both insulin andoral hypoglycemic agents. The mean ITAS score was 52.7 with the prevalence of Psychological Insulin Resistance at 82.6%. Age, gender, family history of diabetes, duration of diabetes, duration of insulin use and ability to purchase medication did not influence the positive and or negative attitudes towards insulin therapy (p>0.05). Insulin naïve and insulin treated patients were analyzed for positive and negative attitudes towards insulin therapy and it was found that those on insulin therapy had lower ITAS scores (50.9 versus 59) reflecting lesser degree of negative attitudes in the latter group (p<0.05). Conclusion: The prevalence of psychological insulin resistance among type 2 diabetes patients at Kenyatta National Hospital is high at 82.6%. Patients already on insulin therapy had less psychological resistance as compared to the insulin naïve patients. It is therefore vital to introduce insulin treatment as an option early in Diabetes Self Management education, at diagnosis, to enhance its utility/usefulness/acceptance in the management of Type 2 diabetes