Impact of fear of insulin or fear of injection on treatment outcomes of patients with diabetes

Objective: The adequate attainment and maintenance of good hemoglobin A1c control in diabetes are major challenges. Although insulin use as the mainstay of diabetes treatment has resulted in favorable treatment outcomes, poor adherence/compliance occurs due to factors such as fear of insulin or fear of injection. This study was undertaken to conduct a systematic review of the impact of fear of insulin/injection on the treatment outcomes of diabetes patients. Methods: A structured search of EMBASE, Ovid MEDLINE, PubMed, and PsycINFO for the years 1990-2008 was conducted to identify published English-language articles addressing fear of insulin or fear of injection in diabetes. The following key words and their combinations were used in the search: diabetes, insulin, injection, fear, phobia, and psychological insulin resistance. Google Scholar website was used to search for any additional references. Manual searches on the references of retrieved articles were also performed to find additional studies. Results: Six studies were selected for in depth assessment. The treatment outcomes included hemoglobin A1c in two studies, complications of diabetes in two studies, general health and psychological comorbidities in two studies, and mortality in one study. Although the number of studies was limited, all identified adverse treatment outcomes in diabetes patients with fear of insulin or fear of injection. No studies with outcomes of resource utilizations or costs were identified. Limitations: Most of the studies we reviewed had a cross-sectional design, where the findings primarily presented associations without firm determinations of the impact of fear of insulin/injection on the treatment outcomes of diabetes. Conclusions: Fear of insulin or fear of injection is associated with poor glycemic control, clinical complications, psychological comorbidities, poor general well-being and health status, and increased risk of mortality for diabetes patients.