Assessing Psychological Insulin Resistance in Type 2 Diabetes: a Critical Comparison of Measures
Purpose of Review
This study aims to examine the operationalisation of ‘psychological insulin resistance’ (PIR) among people with type 2 diabetes and to identify and critique relevant measures.
PIR has been operationalised as (1) the assessment of attitudes or beliefs about insulin therapy and (2) hypothetical or actual resistance, or unwillingness, to use to insulin. Five validated PIR questionnaires were identified. None was fully comprehensive of all aspects of PIR, and the rigour and reporting of questionnaire development and psychometric validation varied considerably between measures.
Assessment of PIR should focus on the identification of negative and positive attitudes towards insulin use. Actual or hypothetical insulin refusal may be better conceptualised as a potential consequence of PIR, as its assessment overlooks the attitudes that may prevent insulin use. This paper provides guidance on the selection of questionnaires for clinical or research purpose and the development of new, or improvement of existing, questionnaires.
KeywordsType 2 diabetes Insulin therapy Psychological insulin resistance Treatment intensification Questionnaire Measurement
EHT and JS are supported by the funding provided to The Australian Centre for Behavioural Research in Diabetes by Diabetes Victoria and Deakin University. FP is supported by the University of Southern Denmark.
Compliance with Ethical Standards
Conflict of Interest
All authors declare no external support for any aspect of the submitted work.
EHT has undertaken research funded by an unrestricted educational grant from Abbott Diabetes Care to The Australian Centre for Behavioural Research in Diabetes (ACBRD) and has served on an AstraZeneca advisory board.
FP has received travel grants and funding from Novo Nordisk to his research group. FP co-developed the Insulin Treatment Appraisal Scale (ITAS).
JS has served as an advisory board member for Roche Diabetes Care, Sanofi ANZ and Janssen Pharmaceuticals. Her research group (ACBRD) has received unrestricted educational grants from Abbott Diabetes Care and Sanofi ANZ and consultancy income from Roche Diabetes Care, AstraZeneca and Sanofi ANZ.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance ••Of major importance
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