Multiple Daily Insulin Injections Improve Self-confidence

Abstract

The efficacy and psychosocial effects of multiple daily insulin injections (three preprandial injections of short-acting insulin (NovoPen) and once daily, bedtime extended-acting insulin) were compared with those of twice daily combinations of short- and intermediate-acting insulin, in a randomized crossover study (two 6-month periods), in 16 adult diabetic patients. HbA1 was not significantly different for the two treatment modalities (8.2 +/- 0.4 vs 7.6 +/- 0.4%). With the pen-injector regimen significantly less state anxiety (36.0 +/- 2.5 vs 39.5 +/- 2.7; p less than 0.05) was found than with the conventional syringe regimen. The patients tended to experience a better self-concept as having diabetes (32.0 +/- 2.1 vs 37.7 +/- 3.0; p less than 0.06), as well as less external ('chance') orientation (18.5 +/- 1.2 vs 20.7 +/- 1.6; p = 0.09) with the pen-injector regimen. A subgroup of patients with lower trait anxiety scores experienced less state anxiety during the pen-injector regimen than during twice daily insulin injections (30.6 +/- 2.6 vs 34.3 +/- 2.7; p less than 0.05). However, this subgroup tended to be less positive about injecting insulin during the pen-injector regimen (34.8 +/- 3.6 vs 29.6 +/- 4.0; p less than 0.08). The subgroup with higher trait anxiety scores experienced a better self-concept as having diabetes (35.3 +/- 2.3 vs 40.1 +/- 2.6; p less than 0.05) and a tendency towards less physician orientation (15.8 +/- 1.8 vs 19.6 +/- 2.7; p less than 0.07) with the pen-injector regimen. Thirteen patients continued with the pen-injector regimen.