Should we Fear Insulin Therapy in the Treatment of Type 2 Diabetes

Obesity is the primary risk factor for the development of type 2 diabetes (T2DM) and, as the prevalence of obesity continues to increase, so does the incidence of type 2 diabetes. For most patients with T2DM, the disease will progress beyond the control of lifestyle measures, diet and oral glucose-lowering drugs. In these patients, insulin therapy is ultimately required to lower blood glucose concentrations to acceptable levels. 'Psychological insulin resistance' is a major barrier to the initiation of insulin therapy for patients with T2DM and for clinicians treating them. This may have a negative impact on patients' health and weight, and also the healthcare system due to increased incidence of diabetes- related complications if HbA1c remains poorly controlled. Ensuring timely and appropriate initiation of insulin therapy requires physicians to recognize patients' fears and to reassure them. This review explores the concerns behind psychological insulin resistance and how they can potentially be addressed in light of recent developments in the treatment of diabetes.