Psychological Barriers to Insulin Treatment

July 28, 2016

Why do adolescents with type 1 diabetes fail to meet the international HbA1c treatment target? What can be done to overcome treatment barriers?

Assessing and addressing psychological barriers to optimal insulin therapy may be a clinically important starting point for treatment, and a possible supplement to standard care of type 1 diabetes (T1DM), according to a new study.

The study, which investigated potential psychological barriers to optimal insulin therapy in male and female adolescents with T1DM, found significant gender differences in illness perceptions, insulin concern, and social-coping and family-coping strategies. “Specifically, females scored significantly higher than males on all illness perception dimensions, indicating that females generally held more negative views about their T1D than males,” state the authors, led by Line Wisting of Oslo University Hospital, Oslo, Norway.

They state that their study is the first one to specifically test gender differences in adolescents with T1DM.

Adolescents with T1DM have been found to suffer from more depression, anxiety, and eating disorders than non-diabetic adolescents. “Key clinical outcomes, such as metabolic control (measured by glycated hemoglobin (HbA1c)) and eating disorder psychopathology have been shown to be significantly related to psychological aspects, including illness perceptions, insulin beliefs, and coping strategies,” the authors state.

The study of 105 adolescents investigated the psychological barriers (illness perceptions, insulin beliefs, and coping strategies) to optimal insulin therapy among adolescents with T1DM, with a specific focus on gender differences and mode of treatment (insulin pump vs pen).

The adolescents completed the Brief Illness Perception Questionnaire, the Beliefs about Medicines Questionnaire, and the Adolescent Coping Orientation for Problem Experiences. Additionally, diabetes clinical data were collected by the Norwegian Childhood Diabetes Registry.

The results show that females had significantly more negative illness perceptions than males on all dimensions. Regarding insulin beliefs, females scored significantly higher than males on “insulin concern,” indicating more concerns about insulin. There were no significant gender differences on perceptions of “insulin necessity.” Females scored significantly higher on the coping strategies “being social” and “solving family problems,” indicating more positive coping among females than males.

The only statistically significant difference in the psychological aspects was for the illness perception “treatment control” -- patients using insulin pen reported more negative perceptions than patients using insulin pump. The authors note that a meta-analysis found better metabolic control among adolescents treated with insulin pump versus insulin pens.

They believe that insulin beliefs, especially insulin concerns, are particularly important to address among adolescents with T1DM “to facilitate positive attitudes to insulin and adequate insulin dosages. Adolescence is usually the time where the daily responsibility for T1DM treatment is transferred from parents to the young patients themselves, and this may lead to greater distress regarding insulin,” they state.

The authors conclude: “An integrated multidisciplinary treatment approach which includes psychological aspects might broaden our understanding of why only one-third of adolescents currently meet the international treatment target of HbA1c<7.5% and may potentially contribute to better treatment and consequently reduced risk of serious diabetes late complications. The consistent finding of gender differences across the psychological measures implies that a tailored treatment approach for males and females with T1D may be warranted.”

Reference: Wisting L, et al. Psychological barriers to optimal insulin therapy: more concerns in adolescent females than males. BMJ Open Diab Res Care. 2016;4:e000203.