We concluded that there is a great need of evidence-based interventions that help remove psychological barriers about insulin use in patients, as well as in health care providers. Strategies proposed to reduce PIR are educational and psychological (exposure, desensitisation, relaxation and counselling). Physicians mainly delay insulin because they lack knowledge on guidelines or pancreas physiology, they fear inducing hypoglycaemia in elderly or impaired patients, and/or they lack time or personnel resources to teach initiation. The main categories are emotional, cognitive, social/cultural, and interaction with health providers. The results showed that a large number of factors account for PIR in patients.

Topics reviewed included: research methods, instruments to assess PIR, PIR in patients and in the medical care team, and proposed strategies for overcoming it. Medline, PubMed, Cochrane reviews, PsycInfo, ProQuest, Science Direct, and EBSCO databases were searched and 60 studies were included in the final review. 3 Aims The objectives of this paper were to answer the following questions: (1) How is PIR measured and studied? (2) What instruments are used to measure PIR? (3) What factors predict PIR in patients and in health care providers? and (4) What interventions have been proposed to reduce PIR? ABSTRACT Our objective was to conduct a critical review of the factors that account for psychological insulin resistance (PIR) and of the available strategies to reduce it. 2 A costanalysis of patients who started insulin therapy showed that health care costs initially increased by 10%, but that expenditures were reduced by 40% in the following nine months. 1 By preventing patients from taking the insulin they need, PIR can cause patients glycaemia levels to fall beyond recommended targets, and can put patients at risk for developing complications which can in turn reduce their quality of life and increase societal burden.

This concept is defined in studies mostly as a diabetes management obstacle influenced by psychological factors (cognitive, emotional, relational, and cultural) and not as a psychological disorder. Barriers are found in patients as well as in health care providers. Of the studies on this subject, most define PIR as reluctance to initiate insulin treatment however, about a quarter of them also consider PIR to include insulin injections omission. 1 : a critical review of the literature A Gherman*, IA Veresiu, RA Sassu, JB Schnur, BL Scheckner, GH Montgomery Introduction (PIR) refers to psychological barriers to initiation and persistence with insulin therapy.

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