Online education may ease insulin fears of adults with type 2 diabetes
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Adults with type 2 diabetes viewing a web-based psychoeducational resource reported feeling less negatively about insulin at 2 weeks compared with baseline, according to study data published in Diabetic Medicine.
“One in four adults with type 2 diabetes report being unwilling to commence insulin if recommended, and this is associated with delayed insulin uptake,” Elizabeth Holmes-Truscott, PhD, research fellow at The Australian Centre for Behavioural Research in Diabetes in Victoria, Australia, told Healio. “In addition to interventions addressing therapeutic inertia at the system and health professional levels, there is an unmet need for effective and scalable interventions which directly target such psychological barriers among people with type 2 diabetes. We designed ‘Is insulin right for me?’, a self-directed online resource, to address this gap.”
Addressing barriers to insulin
Holmes-Truscott and colleagues conducted a double-blind, parallel group, two-arm randomized controlled trial. Adults aged 18 to 75 years from Australia with type 2 diabetes who used oral diabetes agents, had access to the internet, had no experience self-administering an injectable treatment for any illness and reported being “not at all,” “not very,” or “moderately willing” to start insulin therapy were recruited. Participants were randomly assigned to an intervention group with access to a web-based psychoeducational resource detailing behavioral change techniques for eight psychological barriers to insulin therapy or a control group with access to a webpage with two links to publicly available fact sheets published by the National Diabetes Services Scheme in Australia.
“Eight salient psychological barriers to insulin were identified from the literature and framed as questions,” Holmes-Truscott said. “For example, ‘does insulin mean my diabetes is more serious?’ Each barrier was classified using the theoretical domains framework and mapped to relevant behavior change techniques. This informed the aims, content and format of eight webpages each corresponding to a different barrier and question. Improvements were made following content review by external invited peer reviewers as well as six people with type 2 diabetes.”
Clinical, psychosocial and study acceptability data were collected through surveys at baseline and 2 weeks. The Insulin Treatment Appraisal Scale was used to measure negative insulin appraisals, with a higher score indicating greater negative attitude toward insulin.
Fewer insulin appraisals with intervention
There were 35 participants enrolled in the study at baseline, with 17 in the intervention group and 18 in the control group. Fifteen people in the intervention group and 13 in the control group completed the follow-up survey. The intervention webpage was accessed 25 times during the study, with 10 of the 15 participants in the intervention groups. Eleven participants visited the webpages detailing insulin therapy barriers, and seven visited all eight barrier pages. All of the intervention participants said the resource was helpful and included the right information compared with 69% in the control group.
At 2 weeks, the intervention group had a reduction in negative insulin appraisals compared with baseline (mean difference, –6.5; 95% CI, –10.7 to –2.4). There was no significant change in negative insulin appraisals in the control group. Diabetes knowledge and diabetes self-efficacy did not change in either group at 2 weeks, and the intervention group did not have a change in diabetes distress.
Researchers received 79 free-text acceptability responses from 12 intervention participants at follow-up. One-third of all responses reported general satisfaction or included no comments for improvement. Some asked for more specific clinical information, whereas others suggested having an alternative format to present the content, such as accompanying hard copy materials or links to a support line. Some participants said they still had ongoing concerns or felt a stigma attached to insulin.
The researchers wrote that the study confirmed the feasibility of the trial, paving the way for a fully powered randomized controlled trial to be conducted with a longer follow-up.
“Future research is needed to examine the effectiveness of the intervention in terms of timely insulin uptake among adults with type 2 diabetes for whom treatment intensification is clinically indicated, as well as real-world implementation outcomes,” the researchers wrote.
For more information:
Elizabeth Holmes-Truscott, PhD, can be reached at etruscott@acbrd.org.au.
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