‘Is insulin right for me?’: a website for people with type 2 diabetes

The Centre has developed and tested a new website to reduce myths and misconceptions about insulin for type 2 diabetes

By Dr Elizabeth Holmes-Truscott ^[1]

Insulin is an effective treatment for type 2 diabetes (T2D). Around 25% of Australians with T2D inject insulin. That is more than 300,000 people. However, insulin treatment is often delayed. Around one in four adults with T2D ^[2] report that they are not willing to inject insulin if recommended by their health professional. This reluctance is often called ‘psychological insulin resistance’ ^[3]. It is often based on myths and misconceptions, and fears.

Dr Holmes-Truscott ^[1] and colleagues have developed a new online resource ^[4] called ‘Is insulin right for me?’. The resource is informed by our research and designed to support behaviour change. It was reviewed by people with T2D and professional experts. The resource addresses eight key concerns about insulin. Each concern is phrased as question. Responses are provided using text, images, videos, case studies and quizzes. The eight questions are listed below along with brief answers.

1. 1. 1. Does insulin mean my diabetes is more serious? No. Diabetes is always serious. Several different treatments are available to manage your diabetes. Insulin injections may now be the right treatment for you.
      2. Do insulin injections cause complications? Insulin injections do not cause complications. Insulin can lower your risk of complications.
      3. Is it my fault I need to inject insulin? No. You are not to blame if you need a change in your medications. Your diabetes is changing. Insulin may now be the best treatment for you.
      4. Will I gain weight? A small amount of weight gain can be expected in the short-term. There are things you can do to limit weight gain. Your healthcare professional will help you.
      5. Will injecting hurt? Injecting insulin might feel uncomfortable at first, but it shouldn’t hurt. Insulin pens have very fine needles. They can be used with little discomfort.
      6. What about hypos? Insulin lowers blood glucose which may increase the risk of hypos. Like any medication, insulin can cause side-effects. Your healthcare professional will discuss these with you.
      7. Will injecting insulin be a burden? Most people find injecting insulin quick and easy. But it can take a little time to adjust to fitting insulin injections into your life.
      8. What will others think of me? I don’t know. What’s important is how I think and feel about my choice. Talking about insulin injections can help others understand.

The resource was piloted in a small randomised controlled trial ^[5]. Australians with T2D who reported concerns about insulin were invited to take part. Thirty-five people were allocated at random to view either the new ‘Is Insulin right for me?’ website, or to view existing online factsheets about T2D. They completed surveys before and after viewing their allocated resource.

Our pilot trial found that the new website was acceptable. It was also associated with a reduction in negative attitudes about insulin. We also found ways to improve the website, e.g. print friendly webpages and better navigation. Our findings informed minor website refinements. We have since completed a larger randomised controlled trial ^[6] to test how effective the resource is. Findings will be published soon. 

To read more of our research about psychological insulin resistance ^[3] check out our previous blogs on this topic ^[3]. You might also be interested in the NDSS Starting Insulin ^[7] booklet designed for people with T2D who want to find out more about insulin. 

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References:

Holloway EE, Speight J, Furler J, Hagger V, O’Neal D, Skinner TC, Holmes-Truscott E. ‘Is Insulin Right for Me?’ Development of a theory-informed, web-based resource for reducing psychological barriers to insulin therapy in type 2 diabetes ^[4]. BMJ Open, 2021; 11:e045853. 

Holmes-Truscott E, Holloway EE, Husin HM, Furler J, Hagger V, Skinner T, Speight J. ‘Is insulin right for me?’: Feasibility of a pilot randomised controlled trial and acceptability of a web-based intervention to reduce psychological barriers to insulin therapy among adults with type 2 diabetes ^[5]. Diabetic Medicine 2022; 39,3: e14759 doi.org/10.1111/dme.14759 

Holmes-Truscott E, Holloway EE, Husin HM, Furler J, Hagger V, Skinner T, Speight J. Web-based intervention to reduce psychological barriers to insulin therapy among adults with non-insulin-treated type 2 diabetes: study protocol for a two-armed randomized controlled trial of ‘Is Insulin right for me?’ ^[6]  BMJ Open, 2022, 12: e051524