2型糖尿病患者心理性胰岛素抵抗影响因素的范围综述
Factors Influencing Psychological Insulin Resistance in Patients with Type 2 Diabetes Mellitus: A Scoping Review
DOI: 10.12677/acm.2026.162385, PDF,   
作者: 韩意洁, 代丽娟, 何佳容, 杨春艳, 邹易君：南华大学护理学院，湖南 衡阳；谭玲玲*：南华大学附属第二医院护理教研室，湖南 衡阳
关键词: 范围综述；2型糖尿病；心理性胰岛素抵抗；影响因素；Scoping Review； Type 2 Diabetes Mellitus； Psychological Insulin Resistance； Influencing Factors
摘要: 目的：系统梳理2型糖尿病患者心理性胰岛素抵抗的影响因素，为临床制定精准有效的干预方案提供依据。方法：以Arksey和O’Malley范围综述方法学框架为指导，检索中国知网(CNKI)、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、Cochrane Library、CINAHL中的相关文献，检索时限均为建库至2025年1月2日，对纳入文献进行数据提取和汇总。结果：共纳入24篇文献，2型糖尿病患者心理性胰岛素抵抗的影响因素包括糖尿病相关知识缺乏、错误的认知、消极的态度、自我效能、疾病相关因素、人口学因素、宗教文化、社会污名化。不同研究中，心理性胰岛素抵抗的发生率存在差异，为14.9%~97.8%。结论：8种因素间交互作用，共同影响2型糖尿病患者的心理性胰岛素抵抗。临床干预时，需基于患者个体特征，实施精准化干预策略，以提高干预效果，改善患者预后。
Abstract: Objective: To systematically review the influencing factors of psychological insulin resistance in patients with type 2 diabetes mellitus, providing a basis for the clinical development of precise and effective intervention strategies. Methods: Guided by the Arksey and O’Malley framework for scoping reviews, relevant literature was retrieved from CNKI, Wanfang, VIP, China Biomedical Literature Database, PubMed, Web of Science, Cochrane Library, and CINAHL. The search period was from the establishment of the databases to January 2, 2025. Data extraction and summary were conducted for the included literature. Results: A total of 24 articles were included. The influencing factors of psychological insulin resistance in patients with type 2 diabetes include lack of diabetes-related knowledge, incorrect cognition, negative attitude, self-efficacy, disease-related factors, demographic factors, religious culture, and social stigmatization. The incidence of psychological insulin resistance varies among different studies, ranging from 14.9% to 97.8%. Conclusion: The eight factors interact with each other and jointly affect psychological insulin resistance in patients with type 2 diabetes. In clinical intervention, precise intervention strategies should be implemented based on individual characteristics of patients to improve intervention effects and patient prognosis.
文章引用：韩意洁, 代丽娟, 何佳容, 杨春艳, 邹易君, 谭玲玲. 2型糖尿病患者心理性胰岛素抵抗影响因素的范围综述[J]. 临床医学进展, 2026, 16(2): 233-243. https://doi.org/10.12677/acm.2026.162385

参考文献

[1] Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B.B., et al. (2022) IDF Diabetes Atlas: Global, Regional and Country-Level Diabetes Prevalence Estimates for 2021 and Projections for 2045. Diabetes Research and Clinical Practice, 183, Article ID: 109119. [Google Scholar] [CrossRef] [PubMed]
[2] 中国2型糖尿病防治指南(2020年版) (上) [J]. 中国实用内科杂志, 2021, 41(8): 668-695.
[3] Hanefeld, M., Fleischmann, H., Siegmund, T. and Seufert, J. (2020) Rationale for Timely Insulin Therapy in Type 2 Diabetes within the Framework of Individualised Treatment: 2020 Update. Diabetes Therapy, 11, 1645-1666. [Google Scholar] [CrossRef] [PubMed]
[4] Chen, R., Aamir, A.H., Feroz Amin, M., Bunnag, P., Chan, S.P., Guo, L., et al. (2024) Barriers to the Use of Insulin Therapy and Potential Solutions: A Narrative Review of Perspectives from the Asia-Pacific Region. Diabetes Therapy, 15, 1261-1277. [Google Scholar] [CrossRef] [PubMed]
[5] Ahlqvist, E., Prasad, R.B. and Groop, L. (2020) Subtypes of Type 2 Diabetes Determined from Clinical Parameters. Diabetes, 69, 2086-2093. [Google Scholar] [CrossRef] [PubMed]
[6] 张世龙, 张馨丹, 范文瑜, 等. 身心健康在糖尿病患者受歧视程度与心理性胰岛素抵抗之间的中介作用[J]. 现代预防医学, 2024(17): 3073-3076, 3113.
[7] 吴元虹, 王晓辉, 许惠靖, 等. 糖尿病患者心理性胰岛素抵抗的概念分析[J]. 中华护理教育, 2023, 20(8): 986-990.
[8] Zhang, S., Zhang, X., Wang, H., Fan, W., Ma, X., Song, S., et al. (2024) Factors Associated with Psychological Insulin Resistance among Patients with Type 2 Diabetes in China. Frontiers in Endocrinology, 15, Article ID: 1368132. [Google Scholar] [CrossRef] [PubMed]
[9] Wang, W., Men, L., Wang, Y., Shi, C., Yin, H., Li, H., et al. (2024) Effect of Needle-Free Injection on Psychological Insulin Resistance and Insulin Dosage in Patients with Type 2 Diabetes. Frontiers in Endocrinology, 15, Article ID: 1379830. [Google Scholar] [CrossRef] [PubMed]
[10] Lim, A. and Song, Y. (2020) The Role of Psychological Insulin Resistance in Diabetes Self‐Care Management. Nursing Open, 7, 887-894. [Google Scholar] [CrossRef] [PubMed]
[11] Colquhoun, H.L., Levac, D., O'Brien, K.K., Straus, S., Tricco, A.C., Perrier, L., et al. (2014) Scoping Reviews: Time for Clarity in Definition, Methods, and Reporting. Journal of Clinical Epidemiology, 67, 1291-1294. [Google Scholar] [CrossRef] [PubMed]
[12] 王喜益, 叶志弘, 汤磊雯. 范围综述在护理领域的应用进展[J]. 中华护理杂志, 2019, 54(8): 1259-1263.
[13] Khan, H., Lasker, S.S. and Chowdhury, T.A. (2008) Prevalence and Reasons for Insulin Refusal in Bangladeshi Patients with Poorly Controlled Type 2 Diabetes in East London. Diabetic Medicine, 25, 1108-1111. [Google Scholar] [CrossRef] [PubMed]
[14] Ahmed, U.S., Junaidi, B., Ali, A.W., Akhter, O., Salahuddin, M. and Akhter, J. (2010) Barriers in Initiating Insulin Therapy in a South Asian Muslim Community. Diabetic Medicine, 27, 169-174. [Google Scholar] [CrossRef] [PubMed]
[15] Wang, H. and Yeh, M.C. (2011) Psychological Resistance to Insulin Therapy in Adults with Type 2 Diabetes: Mixed‐method Systematic Review. Journal of Advanced Nursing, 68, 743-757. [Google Scholar] [CrossRef] [PubMed]
[16] Woudenberg, Y.J.C., Lucas, C., Latour, C. and Scholte op Reimer, W.J.M. (2012) Acceptance of Insulin Therapy: A Long Shot? Psychological Insulin Resistance in Primary Care. Diabetic Medicine, 29, 796-802. [Google Scholar] [CrossRef] [PubMed]
[17] Abu Hassan, H., Tohid, H., Mohd Amin, R., Long Bidin, M.B., Muthupalaniappen, L. and Omar, K. (2013) Factors Influencing Insulin Acceptance among Type 2 Diabetes Mellitus Patients in a Primary Care Clinic: A Qualitative Exploration. BMC Family Practice, 14, Article No. 164. [Google Scholar] [CrossRef] [PubMed]
[18] Visram, H. (2013) Patient Barriers to Insulin Use in Multi-Ethnic Populations. Canadian Journal of Diabetes, 37, 202-204. [Google Scholar] [CrossRef] [PubMed]
[19] Haslam, D. (2014) Should We Fear Insulin Therapy in the Treatment of Type 2 Diabetes? The Open Obesity Journal, 6, 70-75. [Google Scholar] [CrossRef] 
[20] Zhenzhen, X., Li, Y., Xiaohui, G., Qingqing, L., Fang, Z., Li, S., et al. (2014) Rejection of Insulin Therapy among Patients with Type 2 Diabetes in China: Reasons and Recommendations. Chinese Medical Journal, 127, 3530-3536. [Google Scholar] [CrossRef] 
[21] 倪秀梅, 袁丽. 2型糖尿病患者心理性胰岛素抵抗的现状及影响因素[J]. 中国实用护理杂志, 2014, 30(27): 39-42.
[22] Polonsky, W.H., Fisher, L., Guzman, S., Villa-Caballero, L. and Edelman, S.V. (2005) Psychological Insulin Resistance in Patients with Type 2 Diabetes. Diabetes Care, 28, 2543-2545. [Google Scholar] [CrossRef] [PubMed]
[23] Tan, W., Asahar, S. and Harun, N. (2015) Insulin Therapy Refusal among Type II Diabetes Mellitus Patients in Kubang Pasu District, Kedah, Malaysia. Singapore Medical Journal, 56, 224-227. [Google Scholar] [CrossRef] [PubMed]
[24] Yilmaz, A., Ak, M., Cim, A., Palanci, Y. and Kilinc, F. (2016) Factors Influencing Insulin Usage among Type 2 Diabetes Mellitus Patients: A Study in Turkish Primary Care. European Journal of General Practice, 22, 255-261. [Google Scholar] [CrossRef] [PubMed]
[25] 黄灵娟, 马春苏. 初诊2型糖尿病病人心理胰岛素抵抗的质性研究[J]. 全科护理, 2016, 14(13): 1348-1350.
[26] Taylor, C.G., Taylor, G., Atherley, A., Hambleton, I., Unwin, N. and Adams, O.P. (2017) The Barbados Insulin Matters (BIM) Study: Barriers to Insulin Therapy among a Population-Based Sample of People with Type 2 Diabetes in the Caribbean Island of Barbados. Journal of Clinical & Translational Endocrinology, 8, 49-53. [Google Scholar] [CrossRef] [PubMed]
[27] Hussein, A., Mostafa, A., Areej, A., Mona, A., Shimaa, A., Najd, A., et al. (2019) The Perceived Barriers to Insulin Therapy among Type 2 Diabetic Patients. African Health Sciences, 19, Article No. 1638. [Google Scholar] [CrossRef] [PubMed]
[28] Yu, J.H., Kim, H.Y., Kim, S.R., Ko, E. and Jin, H.Y. (2019) Factors Influencing Psychological Insulin Resistance in Type 2 Diabetes Patients. International Journal of Nursing Practice, 25, e12733. [Google Scholar] [CrossRef] [PubMed]
[29] Ngassa Piotie, P., Wood, P., Webb, E.M., Marcus, T.S. and Rheeder, P. (2020) Willingness of People with Type 2 Diabetes to Start Insulin Therapy: Evidence from the South African Tshwane Insulin Project (TIP). Diabetes Research and Clinical Practice, 168, Article ID: 108366. [Google Scholar] [CrossRef] [PubMed]
[30] Inbaraj, L., Raghavendran, S. and Norman, G. (2020) Reason for Refusal of Insulin Therapy among Type 2 Diabetes Mellitus Patients in Primary Care Clinic in Bangalore. Journal of Family Medicine and Primary Care, 9, Article No. 854. [Google Scholar] [CrossRef] [PubMed]
[31] Soylar, P., Kadioglu, B. and Kilic, K. (2020) Investigation of the Barriers about Insulin Therapy in Patients with Type 2 Diabetes. Nigerian Journal of Clinical Practice, 23, Article No. 98. [Google Scholar] [CrossRef] [PubMed]
[32] Ngassa Piotie, P., Muchiri, J.W., Webb, E.M. and Rheeder, P. (2022) Assessing Barriers to Insulin Therapy among People with Type 2 Diabetes in South Africa Using the Insulin Treatment Appraisal Scale: A Cross-Sectional Survey. Primary Care Diabetes, 16, 509-514. [Google Scholar] [CrossRef] [PubMed]
[33] Salih, R.A., Al-Dewachi, A.B., Yassen, Z.M. and Ibrahim, S.A. (2024) Patient’s Barrier to Initiate Insulin Therapy for Type 2 D.M. Irish Journal of Medical Science (1971-), 194, 161-166. [Google Scholar] [CrossRef] [PubMed]
[34] 董凯瑞, 张倩, 刘书杭, 等. 中青年2型糖尿病患者心理性胰岛素抵抗现状及影响因素分析[J]. 当代护士(上旬刊), 2024, 31(11): 107-111.
[35] 韩小雪, 柯舒雅, 赖鸿飞, 等. 2型糖尿病患者心理性胰岛素抵抗的影响因素及路径分析[J]. 广东药科大学学报, 2024, 40(6): 97-103.
[36] 倪秀梅, 袁丽. 应用胰岛素访谈工具包对2型糖尿病患者心理性胰岛素抵抗的影响研究[J]. 中国实用护理杂志, 2015, 31(25): 1897-1901.
[37] 陈心茹, 赵立, 瞿建铃, 等. 基于健康行动过程取向理论的护理干预在2型糖尿病患者中的应用效果[J]. 当代护士(上旬刊), 2025, 32(12): 36-40.
[38] 王洁, 韦伟, 黄文贞, 等. 书写表达积极情绪干预对中青年2型糖尿病患者病耻感的影响[J]. 护理学杂志, 2022, 37(16): 68-71.
[39] 贾良春, 仲学锋, 马新宇, 等. 安徽省农村2型糖尿病患者自我管理行为与家庭支持、自我效能的关联研究[J]. 中国健康教育, 2025, 41(4): 297-302.

为你推荐