Treating psychological insulin resistance in type 2 diabetes

The phenomenon of psychological insulin resistance (PIR) has been well documented for two decades, but interventions to treat PIR have not been well described. The aim of this study was to describe interventions used to treat psychological insulin resistance by certified diabetes educators (CDE's).

A secondary data analysis study using empirical data from a trial (N = 234) that included four CDEs providing counseling for psychological insulin resistance. Participants not currently using insulin completed the 10-item Barriers to Insulin Therapy measure. The four CDE interventionists documented their approach to addressing participants' barriers to taking insulin using a standard form. Recommendations were collated and summarized.

Strong PIR was shown by 28.4% of participants reporting that they "would not start insulin" and a moderate degree of PIR was shown by 61.2% who said they "would be upset, but would start insulin." The CDE's treated PIR with four primary interventions: 1) teaching and providing explanations, 2) demonstrations and sharing examples of success using insulin therapy, 3) return demonstrations, and 4) addressing feelings and positively managing expectations.

This is the first study to describe in some detail potentially effective patient management strategies for PIR. A randomized controlled trial testing the efficacy of PIR interventions is needed.