Psychological barriers to insulin therapy may delay timely treatment

New research shows that one in four Australians with type 2 diabetes is not willing to use insulin despite their doctor’s recommendation, with this group reporting more concerns or fears about the insulin therapy.

Diabetes Australia CEO, A/Prof Greg Johnson said “Insulin therapy is important and necessary for hundreds of thousands of Australians with type 2 diabetes – there are currently nearly 1.1 million Australians already diagnosed with type 2 diabetes and over 250,000 of these people are using insulin to manage their diabetes – but more people need to use insulin and we need to address the psychological barriers to this necessary treatment.”

Dr Elizabeth Holmes-Truscott, Research Fellow, at the Australian Centre for Behavioural Research in Diabetes (ACBRD) who conducted the study, says psychological barriers to insulin use are common and may lead to the delay of starting beneficial treatment among people with type 2 diabetes. Also, people already using insulin are sometimes reluctant to intensify their insulin treatment.

“In addition to practical concerns about injecting insulin, people also have concerns about what using insulin symbolises,” said Dr Holmes-Truscott. “We found around 70% of people with type 2 diabetes believe that taking insulin would mean their diabetes has become much worse, and 50% report feeling that insulin would mean they’ve ‘failed’ to manage their diabetes. These are powerful ideas that impact on their willingness to use an effective treatment that can benefit their long-term health.”

In response to the research, a new resource from the National Diabetes Services Scheme (NDSS) highlights the prevalence and potential impact of psychological barriers to insulin therapy. The resource, which was developed by the ACBRD in collaboration with Diabetes Australia, is titled: Diabetes and emotional health: A handbook for health professionals supporting adults with type 1 or type 2 diabetes.

Dr Christel Hendrieckx, Senior Research Fellow and a clinical psychologist with the ACBRD, said the Psychological barriers to insulin use chapter in the handbook provides health professionals with practical information and tools to help them identify and address concerns about insulin therapy faced by people with diabetes.

“Health professionals often use people’s reluctance to use insulin as an attempt to motivate people to engage more in lifestyle modifications or taking existing medications – this strategy rarely works and can lead to further delays to treatment intensification. People with diabetes have very real psychological barriers about starting, using or intensifying insulin, and these need to be addressed before they move ahead with insulin use. People want opportunities to talk about their psychological barriers and then work with a health professional who understands these to develop strategies to overcome them.”

“This new resource is important because many health professionals feel that they do not have the appropriate training to offer support to people with diabetes who have psychological barriers to insulin use. It will help health professionals feel more confident to have conversations about these barriers during consultations and discuss effective strategies to work together to overcome insulin use barriers,” Dr Hendrieckx added.

Electronic copies of the Diabetes and Emotional Health handbook and toolkit for health professionals are free and can be accessed here:

A free factsheet addressing concerns about insulin for people with type 2 diabetes has also been developed and can be accessed here.

You can read Dr. Holmes-Truscott’s research here.

The ACBRD is a partnership for better health between Diabetes Victoria and Deakin University.

The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered with the assistance of Diabetes Australia.