Study Protocol: Psychological Insulin Resistance amongst Torres Strait Islanders with Type 2 Diabetes

Background: Despite the well-recognised benefits of insulin therapy in Type 2 diabetes, research has shown that patients are hesitant to commence insulin therapy, a syndrome that is termed by researchers as psychological insulin resistance or PIR. PIR occurs on several levels, emotional; cognitive; behavioural; social and relational. Anecdotally, there is a high proportion of Torres Strait Islanders with poorly controlled diabetes who appear to refuse insulin treatment. Study Aims: This study will identify any potential psychological resistance factors, which are salient for Torres Strait Islanders living in the Torres Strait region who have poorly controlled diabetes, using validated instruments. Methods / Design: A descriptive cross sectional study using the "barriers to insulin treatment questionnaire" and the "insulin treatment appraisal scale" to measure barriers to insulin therapy. Sample Size: Of the 198 adults with diabetes in 5 remote Torres Strait communities, 67 (34%) have an HbA1c equal or greater than 8.5%. Of these 30 are eligible for this study (not currently receiving insulin). 30 respondents will give this study 80% power to detect a correlation coefficient of 27% or more, as a measure of agreement between the two scales. Discussion: Low rates in insulin therapy and self-monitoring in this high risk population needs to be investigated and addressed appropriately. PIR is potentially an important barrier to treatment escalation.