Jens Harald Kongsø

Psychological insulin resistance: patient beliefs and implications for diabetes management

PurposeTo define and understand patient psychological insulin resistance (PIR) and its impact on diabetes management.MethodsSystematic literature review of peer-refereed journals using the MEDLINE database, including all articles in English from 1985 to 2007. The population included patients with type 1 and type 2 diabetes, insulin naïve, and those currently using insulin. A total of 116 articles were reviewed.ResultsPIR is impacted by patients’ beliefs and knowledge about diabetes and insulin, negative self-perceptions and attitudinal barriers, the fear of side effects and complications from insulin use, as well as lifestyle adaptations, restrictions required by insulin use, and social stigma. These etiological influences, both independently and in combination, constitute a patient’s PIR and may result in the reluctance of patients to both initiate and intensify treatment, leading to delayed treatment initiation and compromised glucose control.ConclusionsPIR is complex and multifaceted. It plays an important, although often ignored, role in diabetes management. Assisting health care professionals in better understanding PIR from the patient’s perspective should result in improved treatment outcomes. By tailoring treatments to patients’ PIR, clinicians may be better able to help their patients begin insulin treatment sooner and improve compliance, thus facilitating target glycemic control.

Examining and interpreting responsiveness of the Diabetes Medication Satisfaction measure

Abstract Objective: Treatment satisfaction (TS) is an important patient reported outcome (PRO) in diabetes as it is correlated with outcomes necessary for optimal treatment (e.g., compliance, self-management behaviour). The objective of this study was to examine the responsiveness of the DiabMedSat, a disease-specific PRO measure, assessing Overall, Burden, Efficacy and Symptom TS. Methods: The DiabMedSat was included in an open label, observational study of the safety and efficacy of biphasic insulin aspart 30 (NovoMix 30*) in routine practice with type 2 diabetes. Responsiveness analyses, examining both internal and external responsiveness, were conducted and minimally important differences (MID) assessed. Results: In 18,817 patients, all TS scores significantly improved after 26 weeks of treatment (p<0.001). The effect sizes for these changes were above 0.5 indicating that the ability to detect change was moderate-to-large in size. Significant differences were found for all TS scores comparing patients who met their HbA1c goal, who improved but did not meet goal and who did not improve (p<0.01), and for patients who experienced a minor hypoglycaemic event and those who did not (p<0.001). DiabMedSat scores were able to detect changes in patients’ own global rating of satisfaction (MID ranging from 5.3 to 11.7) and in physician-rated satisfaction with patients’ HbA1c improvement (MID ranging from 5.3 to 10.2). Conclusions: In the context of an observational study, the DiabMedSat has been shown to be highly responsive to change and can be considered as an acceptable PRO measure for TS in diabetes.

Insulin-taking behavior and memory problems among people with diabetes in five countries: findings from a web survey

Background: The purpose of this study was to explore memory problems that result in nonadherence with insulin treatment in people with diabetes from five countries (USA, UK, Canada, Germany, People’s Republic of China), as well as the impact of memory problems on physical and emotional functioning, work, and diabetes management. Methods: A web survey was conducted in five countries with diabetic patients taking insulin. In three countries, focus groups and interviews with 64 patients treated with insulin were used to develop survey items. Three types of memory problems associated with insulin-taking were examined: unintentionally forgetting (UF), questioning whether or not one took a dose (QT), and questioning how much was taken (QD) over the past month. The survey focused on respondents who had experienced at least one of these memory problems. Results: The incidence of memory problems was high; 93.3% of those eligible for the survey reported having had a memory issue in the previous month. A total of 1,754 patients with type 1 or type 2 diabetes completed the web survey. Sixty-eight percent of respondents reported a UF, 79.6% a QT, and 54.7% a QD. A total of 35.9% of respondents reported experiencing all three memory problems. Respondents reported that memory problems had negative impacts on physical and emotional functioning, as well as time and functioning at work. Many respondents indicated that memory problems led them to taking additional blood glucose measurements and contacting physicians/health care professionals. The results demonstrated some significant dif ferences across countries, some significant variation across patient demographics and disease characteristics, and few significant differences across types of insulin regime. Conclusion: Memory problems related to insulin-taking among people with diabetes were experienced by almost all patients. Memory problems are associated with poorer patient wellbeing and functioning, increased use of health care resources, lost time, and reduced functioning at work. Memory problems should be considered in diabetes treatment in order to improve insulin adherence, diabetes management, and patient outcomes.