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Diabetes Insulin Management Education study (DIMEs)

Many people with type 2 diabetes (T2DM) will require insulin as their diabetes progresses. It is well known that people with T2DM have barriers towards insulin, and it is often delayed by up to five years putting them at further risk of diabetes problems.

Psychological factors such as depressive symptoms, diabetes distress and negative beliefs regarding insulin are more prevalent in insulin naïve samples. However, the role of specific psychological factors with regard to the delay in insulin initiation is understudied as there are few prospective studies which have examined these constructs. Likewise, although psychological therapies, such as motivational interviewing (MI), are known to be effective in T2DM for improving glycaemic control and weight loss these have yet to be applied to the specific problem of insulin initiation in people with T2DM.

The aim of this project is to broaden our understanding as to how psychological factors delay insulin initiation and to apply psychological techniques to the process of insulin initiation in people with T2DM to counter common barriers and improve diabetes self-management.

The aims of this project are to:

  • determine whether psychological factors, such as insulin beliefs, diabetes distress or depressive symptoms, delay time to first insulin prescription in people with T2DM
  • describe patient perspectives of insulin initiation in T2DM
  • develop a psychological intervention integrated into insulin start groups and to establish its feasibility and acceptability as a pilot study prior to a larger RCT

Plan of investigation

This project will employ mixed research methods.

Study 1: is an eight-year follow-up of an existing incident T2DM cohort (n=1790). This prospective study will identify patients who have either started insulin or are at the level of requiring insulin (on maximum doses of 2 oral anti-diabetes medications with poor diabetes control, HbA1c of >/= 7.5% or 58mmols/mol on 2 occasions), to determine whether psychological factors are associated with insulin initiation. Status: Preliminary analysis complete.

Study 2: is a qualitative interview study of ~30 patients who have recently attended or been referred to insulin education to determine barriers to insulin self-management, views on current education courses and their suggestions for additional support. Status: Completed.

Study 3: is a modelling study to develop the manual for a group MI intervention (DIME) as an adjunct to insulin start for people with T2DM. Status: Completed.

Study 4: will recruit 60 patients to test a newly developed group MI intervention as an adjunct to insulin start for people with T2DM in a feasibility RCT. It will determine whether it is acceptable and appropriate for patients and whether the trial can be successfully delivered within primary care. Status: Ongoing.


Experiences of Attending Group Education to Support Insulin Initiation in Type 2 Diabetes: A Qualitative Study