Psychological resistance to insulin therapy in adults with type 2 diabetes: mixed-method systematic review

This paper is a report of a review that aimed to describe the phenomenon of psychological resistance to insulin therapy from the perspective of adults with type 2 diabetes mellitus.

Although the benefits of insulin for people with diabetes who are poorly controlled by oral agents have been established, delay in transition to insulin treatment is common. An understanding of the barriers to insulin from the client's viewpoint provides information to facilitate appropriate and effective care.

Searches were carried out between 1999 and 2009 using computerized databases, three in English language and one in Chinese.

Review design was a mixed-method systematic review, and data abstraction and synthesis were undertaken by thematic synthesis. Reviewed articles were restricted to adults with type 2 diabetes and published in English or Chinese.

Sixteen articles were included. For adults with type 2 diabetes, psychological resistance to insulin therapy could be explained by five themes. Three themes were categorized as cognitive appraisal, including 'people do not see the necessity for insulin and actively seek ways to control blood sugars without insulin', 'people have a holistic view of the consequences of insulin' and 'people see insulin therapy as less feasible'. Two themes were categorized as emotional reactions: 'people see insulin as a source of fear/anxiety', and 'the necessity to start insulin therapy has a very negative connotation for them and is associated with dysfunctional emotions'.

Psychological resistance to insulin therapy can result from a range of personal viewpoints involving cognitive appraisal and/or emotional reactions.