제2형 당뇨병환자에서 인슐린 치료 시작에 대한 저항성 조사

Background: To achieve tight glycemic control in the poorly controlled type 2 diabetic patients with oral hypoglycemic agent, it maybe beneficial to initiate insulin treatment at the early stage. Many patients with type 2 diabetes are often reluctant to begin insulin therapy despite poor glycemic control with oral hypoglycemic agents, this little known phenomenon, often termed ``psychological insulin resistance (PIR)``. This study investigates psychological insulin resistance in Korean patients with type 2 diabetes. Method: This study examined a total of 76 type 2 diabetic patients with poor glycemic control during period of April to July 2006. Through questionnaire and telephone survey, total 24 questions were asked about various attitudes on insulin therapy including psychological barriers and patients` acceptance of this treatment. Subjects were asked to allocate points in 5-point scale (from 5 points for ``very true`` to 1 point for ``very untrue``). Results: The means of psychological rejection, injection-related anxiety and fear of insulin side effects such as hypoglycemia and weight gain were 3.65 ± 0.92, 3.17 ± 0.98 and 2.8 ± 1.02, respectively. Unwillingness was common in insulin therapy, 67% of patient rejected or was unwilling to take insulin. Main reasons of patients most frequently endorsed beginning insulin indicate that disease is worsening, permanence (once you start insulin you can never quit) and sense of personal failure. Furthermore, study indicates that patients`` reasons for avoiding insulin therapy were mainly psychological rejection, which extended far beyond a simple injection related anxiety. Conclusion: PIR was psychological reluctance rather than injection related anxiety. To overcome these psychological barriers to insulin treatment, it is necessary to address appropriate diabetes education including training and counseling with excellent interactive communications between patients and clinicians.