Psychological insulin resistance among patients with diabetes mellitus in Botswana.

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.