52-OR: Emotional Distress and Insulin Initiation in the GRADE Trial

Introduction & Objective: We evaluated if higher emotional distress (depressive symptoms [DS] or diabetes distress [DD]) were associated with lower initiation of basal or rapid-acting insulin among participants enrolled in the GRADE Emotional Distress Study (EDS). Methods: Individuals with type 2 diabetes 6 weeks from time of outcome confirmation vs. never) adjusting for treatment group, diabetes duration, and diabetes complications. Unadjusted logistic regression models examined the association of DS and DD with rapid-acting insulin initiation (any time vs. never). Results: We examined 473 participants expected to start basal insulin per protocol; median age 56.2; 35% female; 66% White, 18% Black, 22% Hispanic; median diabetes duration of 5.2 years. Of these, 170 participants initiated basal insulin ≤6 weeks, 154 initiated >6 weeks, and 149 never initiated. We examined 274 participants expected to start rapid-acting insulin; median age 54.9; 35% female; 62% White, 24% Black, 24% Hispanic; median diabetes duration of 5.4 years. Of these, 100 never initiated rapid acting insulin. Neither DS nor DD were associated with starting basal insulin or rapid-acting insulin. Conclusion: In the GRADE EDS, approximately one third of participants did not start protocol required basal or rapid-acting insulin. Emotional distress does not appear to play a role in insulin initiation among volunteer trial participants. Findings go against commonly held beliefs of 'psychological insulin resistance.'