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LN17-2
Reality of insulin initiation in Type 2 Diabetes Mellitus
Andrea LUK
1,2
.
1
Department of Medicine and Therapeutics, the
Chinese University of Hong Kong (CUHK),
2
Department of Medicine
and Therapeutics, Prince of Whales Hospital, Shatin, Hong Kong SAR,
China
Prevailing evidences indicated that diabetes-related vascular
complications are highly preventable through intensive gly-
caemic control, and that achieving blood glucose targets early
in the disease trajectory translates to latent benefits for
decades beyond. Maintenance of optimal glycaemic control
requires successive up-titration of anti-diabetic drug treat-
ment, and insulin is necessary for the majority of patients due
to natural progressive decline in pancreatic
β
-cell function.
Whilst international guidelines strongly advocate basal
insulin upon failing 2 or 3 non-insulin anti-diabetic drugs,
initiation of insulin therapy is often delayed as a result of
clinical inertia and resistance by patients.
Psychological insulin resistance is a phenomenon that
describes barriers to starting insulin therapy and/or to
adhere to prescribed treatment, and is a common reaction in
up to 40
–
70% of people with diabetes. It encompasses a range
of psycho-cognitive factors including fear of injection, fear of
hypoglycaemia and/or weight gain, poor self-efficacy about
the skills required to administer insulin, anxiety over inter-
ferences with daily living, anticipated social stigmatization,
and misconception about the rationale and efficacy of insulin
therapy. Of the latter, patients may perceive insulin therapy as
a form of punishment for their personal failure to manage
their diabetes, whilst others may have concerns that insulin
causes harm.
Despite high prevalence, psychological insulin resistance is
often under-recognized and inadequately addressed. Culture,
age, and gender are variables that may influence the scope
of psychological insulin resistance, which is also linked to
underlying depression. Failure to initiate insulin therapy in
a timely manner and to comply with the recommended
injection doses and schedule are key factors leading to low
rates of glycaemic target attainment. Health care professionals
should be alerted to the multi-dimensional nature of this
problem and encourage acceptance of insulin therapy by
exploring underlying issues and managing patients
’
concerns
in a positive manner.
Speech Abstracts / Diabetes Research and Clinical Practice 120S1 (2016) S1
–
S39
S39