Dr Elizabeth Holmes-Truscott summaries her publication on assessing psychological insulin resistance in type 2 diabetes. 

by Dr Elizabeth Holmes-Truscott


The initiation or intensification of insulin therapy among people with type 2 diabetes is typically delayed long beyond the point at which the clinical need is identified. One cause of this delay is a phenomenon known as ‘psychological insulin resistance’ (PIR), or the misconceptions, myths, and fears about insulin held by people with type 2 diabetes which may lead to an unwillingness to initiate, use, or intensify insulin therapy. Several questionnaires have been developed to measure PIR. Published in current Diabetes Reports, Dr Holmes-Truscott, Prof Pouwer and Prof Speight have conducted the first critical review of these measures.

PIR has been operationalised and measured in two ways, assessing either the (1) hypothetical unwillingness or actual resistance to use to insulin, or (2) attitudes or beliefs about insulin therapy. We argue that actual or hypothetical insulin refusal may be better conceptualised as a potential consequence of PIR, as its assessment overlooks the attitudes that may prevent insulin initiation or optimal insulin use. Five questionnaires assessing attitudes toward insulin therapy were identified, including two validated (to varying degrees) in English, and three developed for use regardless of insulin treatment status, allowing for the assessment of change in response to insulin initiation. Identified questionnaires had considerable conceptual overlap, but none was fully comprehensive of all aspects of PIR. The rigour and reporting of questionnaire development and psychometric validation varied considerably between measures.

Our review suggests that for most clinical and research purposes in Western countries, the Insulin Treatment Appraisal Scale appears to have the strongest basis for recommendation. However, selection of questionnaire should be guided by the clinical or research aim, taking into consideration the sample (i.e. linguistic and cultural validity), clinical time point (i.e. identifying barriers to insulin initiation, ongoing use, or intensification), and the summarised psychometric strengths and limitations of each measure.

Holmes-Truscott E, Pouwer F, Speight J. Assessing Psychological Insulin Resistance in Type 2 Diabetes: a Critical Comparison of Measures. Current Diabetes Reports, 2017; 17(7): 46.