Psychological insulin resistance: a critical review of the literature

Abstract

objective was to conduct a critical review of the factors that account for psychological insulin resistance (PIR) and of the available strategies to reduce it. Medline, PubMed, Cochrane reviews, PsycInfo, ProQuest, Science Direct, and EBSCO databases were searched and 60 studies were included in the final review. Topics reviewed included: research methods, instruments to assess PIR, PIR in patients and in the medical care team, and proposed strategies for overcoming it. The results showed that a large number of factors account for PIR in patients. The main categories are emotional, cognitive, social/cultural, and interaction with health providers. Physicians mainly delay insulin because they lack knowledge on guidelines or pancreas physiology, they fear inducing hypoglycaemia in elderly or impaired patients, and/or they lack time or personnel resources to teach initiation. Strategies proposed to reduce PIR are educational and psychological (exposure, desensitisation, relaxation and counselling). We concluded that there is a great need of evidence-based interventions that help remove psychological barriers about insulin use in patients, as well as in health care providers. Copyright © 2011 John Wiley & Sons. Practical Diabetes Int 2011; 28(3): 125-128