Psychological Insulin Resistance among Patients with Type 2 Diabetes at Ledzokuku - Krowor Municipal Assembly Hospital, Teshie-Accra

Abstract

Background: T2D is progressive, and over time, there is a decline in beta cell activity of the pancreatic islets resulting in the lack of insulin, which is vital in glucose homeostasis. There is, therefore, the need to initiate insulin, the most potent glucose-lowering agent, in the management of T2D, which often is delayed. Delay of insulin therapy is often due to reluctance by patients, which is known as psychological insulin resistance or reluctance by the clinician known as clinic inertia. The magnitude of psychological insulin resistance and its associated factors among people with type 2 diabetes in Ghana remains unknown. Objective: The objective of this study was to assess psychological insulin resistance among people with type 2 diabetes attending the diabetes clinic at LEKMA General Hospital. Methods: A descriptive cross-sectional study was conducted among people with type 2 diabetes attending the diabetes clinic at LEKMA Hospital for routine follow up. Patients were selected using a systematic random sampling procedure. Psychological insulin resistance was measured using the Insulin Treatment Appraisal Scale. Data on the independent variables were collected using a structured questionnaire. Patients were interviewed while they waited to see the doctor, and their fasting blood glucose values were retrieved from the clinic register. Data were analysed using STATA 15. Chi-square test and a stepwise multivariable logistic regression were done to determine the independent variables that were associated with psychological insulin resistance at 0.05 significant level. The variance inflation factor and tolerance statistics were used to test for multicollinearity. Results: Two hundred and three (203) participants were recruited for the study. Only 16.3% (n=33/203) of patients were on insulin despite a mean fasting blood glucose of 8.7 mmol/l. The majority (78.8%, n=160/203) of patients had poor knowledge of insulin therapy. Psychological insulin resistance present in 57.1% (n=116/203) of patients. The adjusted multivariable logistic regression model showed that the odds of psychological insulin resistance was higher among patients with secondary school education compared to patients who had attained a tertiary level of education (aOR=3.03, 95%CI=1.12-8.13, p-value=0.028). Unemployed patients (aOR=3.44, 95%CI=1.17-10.01, p-value=0.024) and patients with poor knowledge of insulin therapy (aOR=2.45, 95%CI=0.95-6.26, p-value=0.001) were more likely to exhibit psychological insulin resistance. All variables had variance inflation factors less than 10 and tolerance statistics greater than 0.10 indicating no potential collinearity. Conclusion: Educational status, occupation and knowledge of insulin therapy were associated with psychological insulin resistance among people with type 2 diabetes attending diabetes clinic at LEKMA Hospital. More than half of the patients exhibited psychological insulin resistance. Early intervention by clinicians to counsel people with type 2 diabetes effectively at the onset of diagnosis will help curtail the phenomenon of psychological insulin resistance.