Thoughts and Feelings Right Before Taking Insulin for the First Time—Surveyed Adult Type 2 Diabetes Mellitus Patients Experiencing Psychological Insulin Resistance Before Regular Insulin Use, 2017
| Thoughts and Feelings before Starting Insulin for the First Time, n (%) Agree/Strongly Agree | Values by Location | |
|---|---|---|
| United States (n = 120) | Canada (n = 74) | |
| Taking insulin would mean I had failed to manage my diabetes with diet and tablets. | 102 (85.0) | 58 (78.4) |
| Taking insulin would mean my diabetes had become much worse. | 103 (85.8) | 47 (63.5) |
| Taking insulin would help to prevent complications of diabetes. | 80 (66.7) | 53 (71.6) |
| Taking insulin would mean other people would see me as a sick/sicker person. | 60 (50.0) | 30 (40.5) |
| Taking insulin would make life less flexible. | 80 (66.7) | 49 (66.2) |
| I was afraid of injecting myself with a needle. | 74 (61.7) | 41 (55.4) |
| Taking insulin would increase the risk of low blood glucose levels (hypoglycemia). | 42 (35.0) | 33 (44.6) |
| Taking insulin would help to improve my health. | 78 (65.0) | 53 (71.6) |
| Insulin would cause weight gain. | 51 (42.5) | 29 (39.2) |
| Managing insulin injections would take a lot of time and energy. | 63 (52.5) | 40 (54.1) |
| Taking insulin would mean I would have to give up activities I enjoy. | 31 (25.8) | 25 (33.8) |
| Taking insulin would mean my health would deteriorate. | 34 (28.3) | 24 (32.4) |
| Injecting insulin would be embarrassing. | 45 (37.5) | 23 (31.1) |
| Injecting insulin would be painful. | 73 (60.8) | 44 (59.5) |
| It would be difficult to inject the right amount of insulin correctly at the right time every day. | 55 (45.8) | 39 (52.7) |
| Taking insulin would make it more difficult to fulfill my responsibilities (at work, at home). | 36 (30.0) | 23 (31.1) |
| Taking insulin would help to maintain good control of blood glucose (sugar levels). | 81 (67.5) | 54 (73.0) |
| Being on insulin would cause family and friends to be more concerned about me. | 70 (58.3) | 40 (54.1) |
| Taking insulin would help to improve my energy level. | 32 (26.7) | 34 (45.9) |
| Taking insulin would make me more dependent on my doctor. | 53 (44.2) | 36 (48.6) |
| Taking insulin might cause serious health problems, like blindness, kidney problems or amputations. | 26 (21.7) | 24 (32.4) |
| Taking insulin would mean that my diabetes would become a much more serious disease. | 64 (53.3) | 40 (54.1) |
| Taking insulin would mean that I had failed, that I hadn’t done a good enough job taking care of my diabetes. | 95 (79.2) | 51 (68.9) |
| Taking insulin would cause me to lose my job. | 14 (11.7) | 16 (21.6) |
| Taking insulin would mean that I would need to take insulin forever. | 96 (80.0) | 54 (73.0) |
| ITAS Scores | ||
| Total negative items ITAS*,†,‡, mean (SD) | 54.2 (9.9) | 53.1 (11.2) |
| Total positive items ITAS*,†,§, mean (SD) | 14.3 (2.1) | 15.1 (2.8) |
| Total ITAS*,†,‡,§,∥, mean (SD) | 64.0 (10.5) | 62.0 (11.4) |
ITAS, Insulin Treatment Appraisal Scale; SD, standard deviation.
↵* Agreement with statements was categorized as “strongly disagree” (corresponding to 1), “disagree” (corresponding to 2), “neither agree nor disagree” (corresponding to 3), “agree” (corresponding to 4), and “strongly agree” (corresponding to 5).
↵† ITAS scoring is based on Snoek et al.32
↵‡ Total negative ITAS score was calculated by averaging the level of agreement to responses of 16 negatively oriented survey questions.
↵§ Total positive ITAS score was calculated by averaging the level of agreement to responses of four positively oriented survey questions.
↵∥ Total ITAS score was calculated by averaging the level of agreement to responses of the negatively oriented and positively oriented survey questions. The values of the positive-oriented survey questions were reversed (5 = 1, 4 = 2, 3 = 3, 2 = 4, 1 = 5). Higher total ITAS score indicates more negative appraisal of insulin treatment.