Rita Shomba L, Lubaki Fina J-P, Bompeka Lepira F, Ogunbanjo Gboyega A, Ngwala Lukanu P
Centre Hospitalier Mère-Enfant Monkole, Kinshasa, The Democratic Republic of the Congo; and, Department of Family Medicine and Primary Health Care, Protestant University of Congo, Kinshasa.
Afr J Prim Health Care Fam Med. 2019 Jul 22;11(1):e1-e5. doi: 10.4102/phcfm.v11i1.1993.
Psychological insulin resistance (PIR) is a common but unappreciated phenomenon by health care providers with a negative impact on the control of type 2 diabetes mellitus.
To determine the frequency of PIR and its determinants in patients with type 2 diabetes.
This study was conducted in Kinshasa in three health centres providing management of diabetic patients.
This study was a multicentric, cross-sectional study conducted from 01 November 2017 to 31 March 2018 in Kinshasa among 213 type 2 diabetic patients who were taking oral anti-diabetic drugs. A standardised questionnaire, the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ), was used for data collection.
The average age of participants was 59.8 ± 11.1 years with a male to female ratio of 1.5. The prevalence of PIR was 42.7%; and its main determinants were 50 years of age (odds ratios [OR] adjusted 2.05; 95% confidence interval [CI] 1.98-4.27; p = 0.045), the presence of complications (OR adjusted 3.33; 95% CI 1.68-6.60; p = 0.001), lack of knowledge about insulin therapy (OR adjusted 1.96; 95% CI 1.03-3.71; p = 0.040) and the high cost of insulin (OR adjusted 2.32; 95% CI 1.08-4.95; p = 0.030).
The study showed that almost half of type 2 diabetic patients had PIR with the main determinant factors related to the patient and the health system. The establishment of a therapeutic education programme, improved 'provider-patient' communication and the development of approaches to increase access to drugs are crucial to reduce the prevalence of PIR.
心理性胰岛素抵抗（PIR）是一种常见但未得到医疗服务提供者重视的现象，对2型糖尿病的控制有负面影响。
确定2型糖尿病患者中PIR的发生率及其决定因素。
本研究在金沙萨的三个为糖尿病患者提供管理服务的健康中心进行。
本研究是一项多中心横断面研究，于2017年11月1日至2018年3月31日在金沙萨对213名正在服用口服降糖药的2型糖尿病患者进行。使用标准化问卷《中国启动胰岛素态度问卷》（Ch-ASIQ）收集数据。
参与者的平均年龄为59.8±11.1岁，男女比例为1.5。PIR的患病率为42.7%；其主要决定因素为年龄50岁（调整后的优势比[OR]为2.05；95%置信区间[CI]为1.98 - 4.27；p = 0.045）、存在并发症（调整后的OR为3.33；95% CI为1.68 - 6.60；p = 0.001）、对胰岛素治疗缺乏了解（调整后的OR为1.96；95% CI为1.03 - 3.71；p = 0.040）以及胰岛素成本高（调整后的OR为2.32；95% CI为1.08 - 4.95；p = 0.030）。
该研究表明，几乎一半的2型糖尿病患者存在PIR，主要决定因素与患者和卫生系统有关。建立治疗教育项目、改善“医患”沟通以及制定增加药物可及性的方法对于降低PIR的患病率至关重要。
