Psychosocial factors and glycemic control in insulin-naive and insulin-experienced people with type 2 diabetes: a path analysis model

The purpose of this study was to compare the status of psychosocial factors and glycemic control in insulin-naive and insulin-experienced people with type 2 diabetes (T2D). In this observational study on people with T2D, demographic, self-care behavior, resources, and affective variables as well as health-related quality of life were assessed and compared in insulin-naive and insulin-experienced considering the number of oral glucose-lowering drugs (OGLDs). Measured variable path analysis was used to test the association among variables and their effect on HbA1c in both groups. In total, 215 insulin-naive and 165 insulin-experienced patients were recruited in this study. The mean duration of diabetes was 11.7 +/- 7.0years in insulin-experienced and 6.8 +/- 5.4years in insulin-naive (p<0.001). The mean hemoglobin A1c (HbA1c) was significantly higher in insulin-experienced subjects irrespective of the number of OGLDs [68 +/- 20mmol/mol (8.4 +/- 1.8%) vs. 56 +/- 16mmol/mol (7.3 +/- 1.4%); p<0.001]. Moreover, insulin-experienced subjects had significantly higher level of diabetes-related distress (2.2 +/- 0.9 vs. 1.9 +/- 0.8), depression (9.5 +/- 5.5 vs. 8.1 +/- 5.1), anxiety (18.3 +/- 12.0 vs. 15.1 +/- 10.5), and lower knowledge of insulin use considering the results of 9-item insulin-use subscale of Michigan diabetes knowledge test (mean 3.9 +/- 1.8) compared to insulin-naive subjects (p<0.05). Higher levels of distress, depression, and anxiety are found in insulin-experienced people with T2D. Therefore, one should be aware that, at the time of insulin need/initiation, people with T2D have reached a more vulnerable state and this should be taken into consideration when implementing a complex insulin initiation plan.