'Is insulin right for me?': Feasibility of a pilot randomised controlled trial and acceptability of a web‐based intervention to reduce psychological barriers to insulin therapy among adults with type 2 diabetes. Issue 3 (15th December 2021)

• Record Type: Journal Article
• Authors: Holmes‐Truscott, Elizabeth; Holloway, Edith E.; Husin, Hanafi M.; Furler, John; Hagger, Virginia; Skinner, Timothy C.; Speight, Jane
• Is Part Of: Diabetic medicine. Volume 39:Issue 3(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-12-15
• Subjects: attitudes -- intervention -- psychological insulin resistance -- randomised control trial -- type 2 diabetes; Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14759
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: Acceptable and accessible interventions are needed to address 'psychological insulin resistance', which is a common barrier to insulin uptake among adults with type 2 diabetes (T2D). Our aim was to test the feasibility of a randomised controlled trial (RCT) study design and acceptability of a theoretically grounded, psycho‐educational, web‐based resource to reduce negative insulin appraisals among adults with T2D. Methods: A double‐blinded, parallel group, two‐arm pilot RCT (1:1), comparing intervention with active control (existing online information about insulin). Eligible participants were Australian adults with T2D, taking oral diabetes medications. Exclusion criteria: prior use of injectable medicines; being 'very willing' to commence insulin. Primary outcomes: study feasibility (recruitment ease, protocol fulfilment, attrition, data completeness); secondary outcomes: intervention acceptability (intervention engagement, user feedback) and likely efficacy (negative Insulin Treatment Appraisal Scale [ITAS] scores at follow‐up). Online surveys completed at baseline and 2 weeks. Results: During 4‐week recruitment, 76 people expressed interest: 51 eligible and 35 enrolled (intervention = 17, control = 18; median[interquartile range] age = 62[53, 69] years; 17 women). Protocol fulfilment achieved by 26 (74%) participants ( n = 13 per arm), with low participant attrition ( n = 6, 17%). Intervention acceptability was high (>80% endorsement, except format preference = 60%). ITAS negative scores differed between‐groups at follow‐up ( M diff = −6.5, 95% confidence interval: −10.7 to −2.4), favouring the intervention. Conclusions: This novel web‐based resource ("Is insulin right for me?") is acceptable and associated with a likely reduction in negative insulin appraisals, relative to existing resources. This pilot shows the study design is feasible and supports conduct of a fully powered RCT.