Factors Associated with Insulin Reluctance in Individuals with Type 2 Diabetes

描述（由申请人提供）：本培训资助申请（F31）的目的是提供博士前支持，使该研究者能够研究与2型糖尿病患者不愿使用胰岛素治疗相关的因素。关于过渡到胰岛素治疗的需要的常见误解可能会影响患者同意和参与使用处方治疗的2型糖尿病自我管理的能力。目前解决不愿开始和/或增加胰岛素治疗的方法主要是教育性的，使用课程和研讨会来改变态度和行为。然而，很少有研究确定是哪些因素影响了患者不愿使用胰岛素治疗。因此，本研究的总体目的是确定2型糖尿病患者不愿开始胰岛素治疗（胰岛素不愿= IR）的相关因素。具体目的是：1)检查IR的实际预测因素，并描述2型糖尿病患者IR与其社会人口学、生物医学和社会心理因素之间的关系；2)建立IR预测模型。为了达到这些目的，将采用描述性、相关性、横断面研究设计。所有参与者（n=139）将被要求完成一份研究问卷。描述性统计，单变量和双变量分析和多元线性回归将被执行。为了描述IR、社会人口因素、生物医学因素和社会心理因素之间的关系，将计算Pearson相关系数。为了建立IR的预测模型，我们将进行多元线性回归。首先，将检验完整模型的总体r平方的显著性。如果整体模型是显著的，将检验每个单独变量在解释IR方差方面的独特贡献。鉴于糖尿病的巨大负担，公共卫生保健系统正在寻求越来越有效的方法来提供糖尿病护理。拟议的研究将有助于了解IR，特别是为卫生专业人员在治疗2型糖尿病患者时使用更合适的临床方法。因此，医疗保健提供者可以更容易地过渡到胰岛素治疗，并促进及时引入胰岛素治疗，以达到最佳的血糖控制。此外，研究结果可能指导更有效的教育干预，以减少胰岛素治疗的心理障碍。

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.