Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany.
Diabetes Technol Ther. 2013 Aug;15(8):703-11. doi: 10.1089/dia.2012.0257. Epub 2013 Jul 11.
"Psychological insulin resistance" (PIR) is an obstacle to insulin treatment in type 2 diabetes, and patients' expectations regarding alternative ways of insulin delivery are poorly understood.
PIR and beliefs regarding treatment alternatives were analyzed in patients with type 2 diabetes (n=532; mean glycated hemoglobin, 68±12 mmol/mol [8.34±1.5%]) comparing oral antidiabetes treatment, subcutaneous insulin injections, or inhaled insulin. Questionnaires were used to assess barriers to insulin treatment (BIT), generic and diabetes-specific quality of life (Short Form 36 and Problem Areas in Diabetes, German version), diabetes knowledge, locus of control (Questionnaire for the Assessment of Diabetes-Specific Locus of Control, in German), coping styles (Freiburg Questionnaire of Illness Coping, 15-Items Short Form), self-esteem (Rosenberg Self-Esteem Scale, German version), and mental disorders (Patient Health Questionnaire, German version). Patients discussed treatment optimization options with a physician and were asked to make a choice about future diabetes therapy options in a two-step treatment choice scenario. Step 1 included oral antidiabetes drugs or subcutaneous insulin injection (SCI). Step 2 included an additional treatment alternative of inhaled insulin (INH). Subgroups were analyzed according to their treatment choice.
Most patients perceived their own diabetes-related behavior as active, problem-focused, internally controlled, and oriented toward their doctors' recommendations, although their diabetes knowledge was limited. In Step 1, rejection of the recommended insulin was 82%, and in Step 2, it was 57%. Fear of hypoglycemia was the most important barrier to insulin treatment. Patients choosing INH (versus SCI) scored higher regarding fear of injection, expected hardship from insulin therapy, and BIT-Sumscore.
The acceptance of insulin is very low in type 2 diabetes patients. The option to inhale insulin increases the acceptability for some but not the majority of patients.
“心理胰岛素抵抗”（PIR）是 2 型糖尿病胰岛素治疗的障碍，患者对替代胰岛素给药方式的期望尚不清楚。
在 2 型糖尿病患者（n=532；平均糖化血红蛋白 68±12 mmol/mol [8.34±1.5%]）中分析了 PIR 和对替代治疗的信念，比较了口服降糖药物、皮下胰岛素注射或吸入胰岛素。使用问卷评估胰岛素治疗障碍（BIT）、一般和糖尿病特异性生活质量（36 项简短健康调查问卷和糖尿病问题领域，德语版）、糖尿病知识、控制源（糖尿病特定控制源评估问卷，德语版）、应对方式（弗莱堡疾病应对问卷，15 项简短形式）、自尊（罗森伯格自尊量表，德语版）和精神障碍（患者健康问卷，德语版）。患者与医生讨论了治疗优化方案，并在两步治疗选择方案中被要求对未来的糖尿病治疗选择做出选择。步骤 1 包括口服降糖药物或皮下胰岛素注射（SCI）。步骤 2 包括吸入胰岛素（INH）的额外治疗选择。根据他们的治疗选择对亚组进行了分析。
尽管大多数患者的糖尿病知识有限，但大多数患者认为自己的糖尿病相关行为是积极的、以问题为导向的、内部控制的，并倾向于遵循医生的建议。在步骤 1 中，拒绝推荐的胰岛素的比例为 82%，而在步骤 2 中，这一比例为 57%。对低血糖的恐惧是胰岛素治疗的最大障碍。选择 INH（与 SCI 相比）的患者在注射恐惧、对胰岛素治疗的预期困难和 BIT 总分方面得分更高。
2 型糖尿病患者对胰岛素的接受程度非常低。选择吸入胰岛素会增加一些患者的接受度，但不是大多数患者。
