What people with type 2 diabetes think about starting insulin therapy

Picture of a syringe

Clinical question

In type 2 diabetes starting insulin or poorly controlled on oral therapy, what psychological barriers do people experience around initiating insulin therapy?

Making the transition to insulin therapy in type 2 diabetes can be very difficult.  This review set out to identify the psychological barriers people experience when faced with the challenge.

The evidence

The reviewers found sixteen studies.  They extracted qualitative data from each study and came up with five main themes:

  • Not seeing the need for insulin
  • Concerns about the consequences of insulin
  • Difficulty in doing insulin therapy
  • Insulin as a source of fear or anxiety
  • Negative emotional consequences of using insulin

Appraisal hints

Users of this research should consider:

  • Did the reviewers carry out a rigorous assessment of the quality of the included studies?
  • Could they have missed important published or unpublished research?
  • What the full range of reported experiences was
  • Whether the perspective of the analysis reflects your and your patient’s perspective
  • Could the researchers have influenced the reporting of outcomes?
  • Are there any patterns or predictors of beliefs or experiences?
  • How these findings can inform care that better meets the needs of these patients.


Wang HF, Yeh MC. Psychological resistance to insulin therapy in adults with type 2 diabetes: mixed-method systematic review. J Adv Nurs. 2011 Nov 3. doi: 10.1111/j.1365-2648.2011.05853.x. [Epub ahead of print]

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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