Fear, guilt feelings and misconceptions: barriers to effective insulin treatment in type 2 diabetes.

Diabetes self management education, the process of teaching individuals to manage their diabetes, has been considered the cornerstone of the clinical management of individuals with diabetes since the work of the Joslin Diabetes Center. The goals of self-management education are to optimize metabolic control, prevent acute and chronic complications, and optimize quality of life. The keystone to successful management is to involve the patient in his treatment. Clearly, factors other than knowledge and effective therapies affect the behaviors of patients and health care professionals and influence their ability to make optimal use of available treatments. The DAWN study has shown that both health care providers and patients may have a negative attitude toward starting insulin therapy. Patients with type 2 diabetes are very often reluctant to accept insulin therapy. The reasons most commonly encountered, for this negative attitude are: Patients blame themselves, for they consider that starting insulin therapy would indicate they had "failed" proper diabetes self-management. For some patients taking insulin means life will be more restricted or it means they have reached their last resort. Fear of hypoglycemia is a very common barrier for insulin therapy. Physicians may, unconsciously, negatively influence their patients. For some physicians putting his patient on insulin, means that he has failed to control his patient's diabetes on oral agents and now has to force him in a troublesome therapeutic regime. In order to overcome these barriers, health care professionals, rather than trying to "convince" their patients of the necessity of the treatment, should assess, by active listening, the precise reason for which his/her patient denies it.