Psychological insulin resistance among older patients with type 2 diabetes mellitus

Abstract

INTRODUCTION: Despite suboptimal glycemic control, most of the older Type 2 Diabetes Mellitus (DM) patients refuse insulin initiation. OBJECTIVES: To explore oral drug failure T2DM older patientsa€™ view on insulin initiation when oral drugs failed. METHODS: 24 focus groups were performed in 11 general outpatient clinics from July 2013 to May 2014. Data from T2DM subjects age a‰65 with recent glycemic haemoglobulin a‰7.5%; on maximum tolerable oral drugs were extracted to undergo analysis based on the attitude-behaviour model. RESULTS: Total 82 subjects (Men (45.1%) Women (54.9%)), aged 65 to 89 were interviewed. Two-third of them attained primary school or below (75.6%). All subjects believed that more stringent lifestyle modification, mainly by reduction of calories intake could improve their glycemic control, therefore delay insulin initiation. Some of them expressed distrust not only of insulin injection but also of high dose of oral drugs. Most of them felt upset and reluctant when doctors suggested stepping up or addition of new glucose-lowering agents. The medicine provided by government clinics was less effective than the new generation of oral medications which only available in private pharmacy. Overall, most of them did not think insulin would improve their health because they perceived short life-expectancy. Older people should not receive a€˜aggressivea€™ or a€˜invasivea€™ treatment (i.e. starting insulin) with perceived serious or even lethal adverse effect from the treatment. They could stay asymptomatic until death naturally. Subjects with physical barriers and low health literacy were particularly poorly motivated to starting insulin because learning new skills and knowledge seemed to be particularly unachievable.