Psychological insulin resistance among patients with diabetes mellitus in Botswana.

Abstract

Background:  Timely initiation of insulin therapy is vital in patients with type 2 diabetes mellitus. However, insulin initiation may be delayed because of psychological insulin resistance (PIR).

Aim:  This study aims to determine the prevalence of PIR and factors that contribute to PIR in adults with type 2 diabetes mellitus at a diabetes clinic in Botswana.

Setting:  The study was conducted in a diabetes clinic, one of the two large centres in the country that manage diabetes mellitus. It is situated on the south eastern part of Botswana.

Methods:  This was a cross-sectional study among patients with type 2 diabetes mellitus. We included participants aged between 18 and 80 years old and diagnosed with type 2 diabetes mellitus for more than 1 year. Patients' attitudes towards insulin therapy were assessed using the Insulin Treatment Appraisal Scale (ITAS).

Results:  The prevalence of PIR was 82.9% (95% confidence interval [CI]: 78.0 - 87.8) out of the 228 respondents. Factors significantly associated with PIR were gender (odds ratio [OR] adjusted 0.44; 95% confidence interval 0.211 - 0.921; p = 0.029) and treatment type (OR adjusted 1.58; 95% confidence interval 1.067 - 2.341; p = 0.023).

Conclusion:  Significant factors associated with psychological insulin resistance were patient and health system-related. It is therefore pivotal to improve patient and healthcare provider communication and to ensure that patient education is thoroughly performed at the diagnosis of disease.Contribution: This study highlights the importance of patient education at diagnosis and during treatment continuum of diabetes mellitus.