Factors Associated with Insulin Reluctance in Individuals with Type 2 Diabetes

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DESCRIPTION (provided by applicant): The purpose of this training grant application (F31) is to provide predoctoral support that will allow this investigator to examine the factors associated with a reluctance to use insulin therapy in individuals with type 2 diabetes. Common misconceptions about the need for transitioning to insulin therapy may affect a patient's ability to agree to and participate in self-management of type 2 diabetes using the prescribed therapy. Current approaches to address reluctance to begin and/or increase insulin therapy are largely educational, using classes and workshops to change attitudes and behavior. Little research exists, however, to determine which factors influence patients' reluctance to use insulin therapy. Therefore, the overall purpose of this study is to identify the factors related to reluctance to initiate insulin therapy (Insulin Reluctance= IR) in individuals with type 2 diabetes. The specific aims are 1) to examine the actual predictors of IR and to describe the relationship among IR in individuals with type 2 diabetes and their sociodemographic, biomedical, and psychosocial factors; and 2) to develop predictive model of IR. To accomplish these aims, a descriptive, correlational, cross-sectional study design will be used. All participants (n=139) will be asked to complete a study questionnaire. Descriptive statistics, uhivariate and bivariate analyses and multiple linear regression will be performed. To describe the relationship among IR, sociodemographic factors, biomedical factors, and psychosocial factors, Pearson correlation coefficients will be computed. To develop a predictive model of IR, multiple linear regression will be conducted. First the overall R-square of the complete model will be examined for significance. If the overall model is significant, the unique contribution of each separate variable in explaining the variance of IR will be tested. Given the significant burden of diabetes, public health care systems are seeking increasingly effective means of providing diabetes care. The proposed study will contribute to knowledge about IR, specifically about more appropriate clinical approaches for health professionals to use in working with type 2 diabetes patients. Thus, health care providers can make the transition to insulin therapy easier and facilitate timely introduction of insulin therapy to achieve optimal glycemic control. Furthermore, study findings may guide more effective educational interventions to reduce psychological barriers to insulin treatment.