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EFFECT OF NURSING PRACTICES ON FEAR OF INSULIN IN DIABETIC PATIENTS: A SYSTEMATIC REVIEW*

Yıl 2026, Cilt: 4 Sayı: 2, 51 - 75, 26.01.2026

Öz

Fear of injection is associated with several identified factors. These factors can be attributed to two main concerns: past experiences and a lack of knowledge. This systematic review aims to analyze the effectiveness of interventional practices to break 'psychological resistance to insulin,' defined as the fear of self-injection in diabetic patients undergoing insulin treatment. While searching the literature, the PRISMA- P flowchart was used. The search was limited to studies published in English between 2002 and 2023, from 15 November to 30 May 2024, in the databases “Scopus, PubMed, Science Direct, Web of Science, Medline, EBSCOhost, and Cochrane Library Fourteen studies, including 13 randomized controlled trials and one quasi- experimental study, were included in the review. The effectiveness of injection administration, diabetes education programs, the use of narrower or shorter needles, needle-free injections, stress management strategies such as stress inoculation-based techniques and lavender oil, and training support for individuals with diabetes undergoing insulin treatment has been confirmed. Practical demonstrations are important, especially for patients who require self- management intervention. This review suggests that new programs to maintain the self-efficacy of diabetic patients should be further investigated to improve outcomes and reduce hospitalizations and overall costs.

Kaynakça

  • Aleali, A. M., Payami, S. P., Latifi, S. M., Yazdanpanah, L., Hesam, S. & Hacıddin, N. (2018). Evaluation of psychological resistance to insulin treatment in type II diabetic patients. Diabetes Metab Syndr, 12(6), 929-932. https://doi.org/10.1016/j.dsx.2018.05.017
  • Atalla, H. R. (2016). Effectiveness of nursing intervention regarding self-insulin administration among diabetic patients. Clinical Nursing Studies, 4(2), 57-63. https://doi.org/10.5430/cns.v4n2p57
  • Bağriaçik, E. & Bayraktar, N. (2022). Evaluation of the effect of training given according to Pender's Health Promotion Model on psychological insulin resistance. Human Nutrition & Metabolism, 29, 200153. https://doi.org/10.1016/j.hnm.2022.200153
  • Cahn, A., Akirov, A. & Raz, I. (2018). Digital health technology and diabetes management. J Diabetes, 10(1), 10-17. https://doi.org/10.1111/1753-0407.12606
  • Chang, S. Y., Chiang, H. C., Su, H. M., Lin, S. C. & Liu, C. J. (2014). Reducing the incidence of needlestick injuries due to insulin pen injectors among self-users. J Nurs. Hu Li Za Zhi, 61(4), 74-82. https://doi.org/10.6224/jn.61.4.74
  • Choomai, A., Wattanapisit, A. & Tiangtam, O. (2021). Effects of an actual insulin injection demonstration on insulin acceptance among patients with T2DM: A pragmatic randomized controlled trial. Rom J Intern Med, 59(2), 151-158. https://doi.org/10.2478/rjim-2020-0040
  • Davoudi, Z., Chouhdari, A., Mir, M. & Akbarian, F. (2020). Attitude and compliance with the onset of insulin therapy in patients with type 2 diabetes. Shiraz E-Medical Journal, 21(6), e95408. https://doi.org10.5812/semj.95408
  • De Berardis, G., Scardapane, M. & Lucisano, G., et al. (2018). Efficacy, safety and acceptability of the new pen needle 34G × 3.5 mm. Curr Med Res Opin, 34(9), 1699-1704. https://doi.org/10.1080/03007995.2018.1491396
  • Demı˙rağ, H., Hı˙ntı˙stan, S. & Bulut, E. (2022). The effect of topically administered lavender aromatherapy on insulin injection pain. Turk J Med Sci, 52(6), 1845-1853. https://doi.org/10.55730/1300-0144.5531
  • Ghavami, T., Kazeminia, M. & Rajati, F. (2022). The effect of lavender on stress in individuals: A systematic review and meta-analysis. Complementary Therapies in Medicine, 68, 102832. https://doi.org/10.1016/j.ctim.2022.102832
  • Hermanns, N., Ehrmann, D., Schall, S., Maier, B., Haak, T. & Kulzer, B. (2017). The effect of an education programme (MEDIAS 2 BSC) on non‐intensive insulin treatment regimens. Diabet Med, 34(8), 1084-1091. https://doi.org/10.1111/dme.13346
  • Holton, S., Rasmussen, B. S., Turner, J., Steele, C., Ariarajah, D., Hamblin, S., Crowe, S. et al. (2022). Nurse, midwife and patient perspectives and experiences of diabetes management in an acute inpatient setting: a mixed-methods study. BMC Nursing, 21(1). https://doi.org/10.1186/s12912-022-01022-w
  • Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., Ioannidis, J. P. A. et al. (2015). The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Annals of Internal Medicine, 162(11), 777-784. https://doi.org/10.7326/M14-2385
  • Iwanaga, M. & Kamoi, K. (2009). Patient perceptions of injection pain and anxiety: A comparison of Novofine gauge tip 6mm and Micro Fine Plus gauge 5mm needles. Diabetes Technology & Therapeutics, 11(2), 81–86. https://doi.org/10.1089/dia.2008.0027. PMID: 19848573
  • Ji, L., Chen, L., Wang, Y., Ma, Z., Ran, X., Sun, Z., Xu, X. et al. (2019). Study protocol for a prospective, multicenter, randomized, open-label, parallel-group clinical trial comparing the efficacy and safety of a needle-free insulin injector and a conventional insulin pen in controlling blood glucose concentrations in Chinese patients with type 2 diabetes mellitus (The FREE study). Diabetes Therapy, 10(4), 1247-1257. https://doi.org/10.1007/s12325-019-00951-4
  • Ji, L., Gao, L., Chen, L., Wang, Y., Ma, Z., Ran, X., Sun, Z. et al. (2020). Insulin delivery with a needle-free insulin injector versus a conventional insulin pen in Chinese patients with type 2 diabetes mellitus: A 16-week, multicenter, randomized clinical trial (the FREE study). EClinicalMedicine, 27, 100547. https://doi.org/10.1016/j.eclinm.2020.100547
  • Koonmen, L. A., Lennie, T. A., Hieronymus, L., Rayens, M. K., Ickes, M. J., Miller, J. & Mudd‐ Martin, G. (2023). Covid-19 impact predicts diabetes distress among individuals with type 2 diabetes. The Science of Diabetes Self-Management and Care, 49(5), 392-400. https://doi.org/10.1177/26350106231196300
  • Kruger, D. F., LaRue, S. & Estepa, P. (2015). Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 8, 49–56. https://doi.org/10.2147/DMSO.S71923
  • Li, X., Ge, J. & He, L. (2023). Influence of self-practice oriented teaching plus psychological intervention on blood glucose level and psychological state in patients with Type 2 diabetes mellitus on insulin therapy. Evid Based Complement Alternat Med, 2023, 9867917. https://doi.org/10.1155/2023/9867917. PMID: 37387984; PMCID: PMC10307469
  • McMurtry, C. M., Taddio, A., Noel, M., Antony, M. M., Odels, C. T., Asmundson, G. J. G., Pillai Riddell, R., et al. (2016). Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: A clinical practice guideline and call for further research. Cognitive Behaviour Therapy, 45(3), 217-235. https://doi.org/10.1080/16506073.2016.1157204
  • Millan, R. R. A. (2015). Myths and misconceptions about insulin therapy among latinos/ hispanics with diabetes: a fresh look at an old problem. Journal of Diabetes &Amp; Metabolism, 06(01). https://doi.org/10.4172/2155-6156.1000482
  • Misnikova, I. V., Gubkina, V. A., Lakeeva, T. S. & Dreval, A. V. (2017). The impact of proper insulin injection technique training on glycemic control. Diabetes Ther, 8(6), 1309-1318. https://doi.org/10.1007/s13300-017-0315-y
  • Pérez‐Fernández, A., Fernández‐Berrocal, P. & Gutiérrez‐Cobo, M. J. (2023). The relationship between well‐being and hba1c in adults with type 1 diabetes: a systematic review. Journal of Diabetes, 15(2), 152-164. https://doi.org/10.1111/1753-0407.13357
  • Sanz-Pastor, A. G., Enríquez, A. J., Bao, A. S. & Ampudia‐Blasco, F. J. (2024). Current barriers to initiating insulin therapy in individuals with type 2 diabetes. Frontiers in Endocrinology, 15. https://doi.org/10.3389/fendo.2024.1366368
  • Sheno, B. W. & Reja, A. (2021). Knowledge, practice, and attitude of patients and physicians towards insulin therapy in type 2 dm: a cross sectional study in tash patients and physician from various universities in ethiopia. https://doi.org/10.21203/rs.3.rs-1064545/v1
  • Shi, Y., Wang, C., Sevick, M. A., Bao, H., Xu, X., Jiang, Y., Zhu, Z., et al. (2024). Diabetes distress and associated factors among chinese americans with type 2 diabetes in new york city. Diabetes, Metabolic Syndrome and Obesity, Volume 17, 2845-2853. https://doi.org/10.2147/dmso.s459478
  • Skovlund, S., Lyness, W. & Nicklasson, L. (2002). PDB10: A cross-over randomized controlled trial to compare psychological barriers to insulin self-injection with the Innolet and vial/syringe. Value in Health, 5(6), 549. https://doi.org/10.1016/s1098-3015(10)61447-7
  • Stockl, K., Ory, C., Vanderplas, A., Nicklasson, L., Lyness, W., Cobden, D. & Chang, E. (2007). An evaluation of patient preference for an alternative insulin delivery system compared to standard vial and syringe. Current Medical Research and Opinion, 23(1), 133-146. https://doi.org/10.1185/030079906x159524
  • Sugai, K., Shikuma, J., Hiroike, S., Abe, H. & Suzuki, R. (2023). Successful introduction of sensor‐ augmented pump therapy in a patient with diabetes and needle phobia: A case report. Journal of Diabetes Investigation, 14(11), 1318-1320. https://doi.org/10.1111/jdi.14061
  • Valentini, M., Scardapane, M., Bondanini, F., Bossi, A., Colatrella, A., Girelli, A., Ciucci, A. et al. (2015). Efficacy, safety and acceptability of the new pen needle 33G × 4 mm: AGO 01 study. Current Medical Research and Opinion, 31(3), 487-492. https://doi.org/10.1185/03007995.2014.993025
  • Vlachou, E., Ntikoudi, A., Owens, D. A., Nikolakopoulou, M., Chalimourdas, T. & Cauli, O. (2022). Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: An update review of randomized controlled trials. Journal of Diabetes and Its Complications, 36(5), 108185. https://doi.org/10.1016/j.jdiacomp.2022.108185
  • Wang, W., Men, L., Wang, Y., Shi, C., Yin, H., Li, H., Zhou, H. et al. (2024, May 8). Effect of needle-free injection on psychological insulin resistance and insulin dosage in patients with type 2 diabetes. Frontiers in Endocrinology, 15, 1379830. https://doi.org/10.3389/fendo.2024.1379830
  • Xing, Y., Xie, X., Xu, J., Liu, J., He, Q., Yang, W., Zhang, N. et al. (2019). Efficacy and safety of a needle-free injector in Chinese patients with type 2 diabetes mellitus treated with basal insulin: A multicentre, prospective, randomised, crossover study. Expert Opinion on Drug Delivery, 16(9), 995-1002. https://doi.org/10.1080/17425247.2019.1649251
  • Youngwanichsetha, S. (2021). The effect of online computer assisted instruction on knowledge, self- efficacy, and satisfaction of nursing students. International Journal of Nursing Education, 14(1), 181-185. https://doi.org/10.37506/ijone.v14i1.17772.

Yıl 2026, Cilt: 4 Sayı: 2, 51 - 75, 26.01.2026

Öz

Kaynakça

  • Aleali, A. M., Payami, S. P., Latifi, S. M., Yazdanpanah, L., Hesam, S. & Hacıddin, N. (2018). Evaluation of psychological resistance to insulin treatment in type II diabetic patients. Diabetes Metab Syndr, 12(6), 929-932. https://doi.org/10.1016/j.dsx.2018.05.017
  • Atalla, H. R. (2016). Effectiveness of nursing intervention regarding self-insulin administration among diabetic patients. Clinical Nursing Studies, 4(2), 57-63. https://doi.org/10.5430/cns.v4n2p57
  • Bağriaçik, E. & Bayraktar, N. (2022). Evaluation of the effect of training given according to Pender's Health Promotion Model on psychological insulin resistance. Human Nutrition & Metabolism, 29, 200153. https://doi.org/10.1016/j.hnm.2022.200153
  • Cahn, A., Akirov, A. & Raz, I. (2018). Digital health technology and diabetes management. J Diabetes, 10(1), 10-17. https://doi.org/10.1111/1753-0407.12606
  • Chang, S. Y., Chiang, H. C., Su, H. M., Lin, S. C. & Liu, C. J. (2014). Reducing the incidence of needlestick injuries due to insulin pen injectors among self-users. J Nurs. Hu Li Za Zhi, 61(4), 74-82. https://doi.org/10.6224/jn.61.4.74
  • Choomai, A., Wattanapisit, A. & Tiangtam, O. (2021). Effects of an actual insulin injection demonstration on insulin acceptance among patients with T2DM: A pragmatic randomized controlled trial. Rom J Intern Med, 59(2), 151-158. https://doi.org/10.2478/rjim-2020-0040
  • Davoudi, Z., Chouhdari, A., Mir, M. & Akbarian, F. (2020). Attitude and compliance with the onset of insulin therapy in patients with type 2 diabetes. Shiraz E-Medical Journal, 21(6), e95408. https://doi.org10.5812/semj.95408
  • De Berardis, G., Scardapane, M. & Lucisano, G., et al. (2018). Efficacy, safety and acceptability of the new pen needle 34G × 3.5 mm. Curr Med Res Opin, 34(9), 1699-1704. https://doi.org/10.1080/03007995.2018.1491396
  • Demı˙rağ, H., Hı˙ntı˙stan, S. & Bulut, E. (2022). The effect of topically administered lavender aromatherapy on insulin injection pain. Turk J Med Sci, 52(6), 1845-1853. https://doi.org/10.55730/1300-0144.5531
  • Ghavami, T., Kazeminia, M. & Rajati, F. (2022). The effect of lavender on stress in individuals: A systematic review and meta-analysis. Complementary Therapies in Medicine, 68, 102832. https://doi.org/10.1016/j.ctim.2022.102832
  • Hermanns, N., Ehrmann, D., Schall, S., Maier, B., Haak, T. & Kulzer, B. (2017). The effect of an education programme (MEDIAS 2 BSC) on non‐intensive insulin treatment regimens. Diabet Med, 34(8), 1084-1091. https://doi.org/10.1111/dme.13346
  • Holton, S., Rasmussen, B. S., Turner, J., Steele, C., Ariarajah, D., Hamblin, S., Crowe, S. et al. (2022). Nurse, midwife and patient perspectives and experiences of diabetes management in an acute inpatient setting: a mixed-methods study. BMC Nursing, 21(1). https://doi.org/10.1186/s12912-022-01022-w
  • Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., Ioannidis, J. P. A. et al. (2015). The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Annals of Internal Medicine, 162(11), 777-784. https://doi.org/10.7326/M14-2385
  • Iwanaga, M. & Kamoi, K. (2009). Patient perceptions of injection pain and anxiety: A comparison of Novofine gauge tip 6mm and Micro Fine Plus gauge 5mm needles. Diabetes Technology & Therapeutics, 11(2), 81–86. https://doi.org/10.1089/dia.2008.0027. PMID: 19848573
  • Ji, L., Chen, L., Wang, Y., Ma, Z., Ran, X., Sun, Z., Xu, X. et al. (2019). Study protocol for a prospective, multicenter, randomized, open-label, parallel-group clinical trial comparing the efficacy and safety of a needle-free insulin injector and a conventional insulin pen in controlling blood glucose concentrations in Chinese patients with type 2 diabetes mellitus (The FREE study). Diabetes Therapy, 10(4), 1247-1257. https://doi.org/10.1007/s12325-019-00951-4
  • Ji, L., Gao, L., Chen, L., Wang, Y., Ma, Z., Ran, X., Sun, Z. et al. (2020). Insulin delivery with a needle-free insulin injector versus a conventional insulin pen in Chinese patients with type 2 diabetes mellitus: A 16-week, multicenter, randomized clinical trial (the FREE study). EClinicalMedicine, 27, 100547. https://doi.org/10.1016/j.eclinm.2020.100547
  • Koonmen, L. A., Lennie, T. A., Hieronymus, L., Rayens, M. K., Ickes, M. J., Miller, J. & Mudd‐ Martin, G. (2023). Covid-19 impact predicts diabetes distress among individuals with type 2 diabetes. The Science of Diabetes Self-Management and Care, 49(5), 392-400. https://doi.org/10.1177/26350106231196300
  • Kruger, D. F., LaRue, S. & Estepa, P. (2015). Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 8, 49–56. https://doi.org/10.2147/DMSO.S71923
  • Li, X., Ge, J. & He, L. (2023). Influence of self-practice oriented teaching plus psychological intervention on blood glucose level and psychological state in patients with Type 2 diabetes mellitus on insulin therapy. Evid Based Complement Alternat Med, 2023, 9867917. https://doi.org/10.1155/2023/9867917. PMID: 37387984; PMCID: PMC10307469
  • McMurtry, C. M., Taddio, A., Noel, M., Antony, M. M., Odels, C. T., Asmundson, G. J. G., Pillai Riddell, R., et al. (2016). Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: A clinical practice guideline and call for further research. Cognitive Behaviour Therapy, 45(3), 217-235. https://doi.org/10.1080/16506073.2016.1157204
  • Millan, R. R. A. (2015). Myths and misconceptions about insulin therapy among latinos/ hispanics with diabetes: a fresh look at an old problem. Journal of Diabetes &Amp; Metabolism, 06(01). https://doi.org/10.4172/2155-6156.1000482
  • Misnikova, I. V., Gubkina, V. A., Lakeeva, T. S. & Dreval, A. V. (2017). The impact of proper insulin injection technique training on glycemic control. Diabetes Ther, 8(6), 1309-1318. https://doi.org/10.1007/s13300-017-0315-y
  • Pérez‐Fernández, A., Fernández‐Berrocal, P. & Gutiérrez‐Cobo, M. J. (2023). The relationship between well‐being and hba1c in adults with type 1 diabetes: a systematic review. Journal of Diabetes, 15(2), 152-164. https://doi.org/10.1111/1753-0407.13357
  • Sanz-Pastor, A. G., Enríquez, A. J., Bao, A. S. & Ampudia‐Blasco, F. J. (2024). Current barriers to initiating insulin therapy in individuals with type 2 diabetes. Frontiers in Endocrinology, 15. https://doi.org/10.3389/fendo.2024.1366368
  • Sheno, B. W. & Reja, A. (2021). Knowledge, practice, and attitude of patients and physicians towards insulin therapy in type 2 dm: a cross sectional study in tash patients and physician from various universities in ethiopia. https://doi.org/10.21203/rs.3.rs-1064545/v1
  • Shi, Y., Wang, C., Sevick, M. A., Bao, H., Xu, X., Jiang, Y., Zhu, Z., et al. (2024). Diabetes distress and associated factors among chinese americans with type 2 diabetes in new york city. Diabetes, Metabolic Syndrome and Obesity, Volume 17, 2845-2853. https://doi.org/10.2147/dmso.s459478
  • Skovlund, S., Lyness, W. & Nicklasson, L. (2002). PDB10: A cross-over randomized controlled trial to compare psychological barriers to insulin self-injection with the Innolet and vial/syringe. Value in Health, 5(6), 549. https://doi.org/10.1016/s1098-3015(10)61447-7
  • Stockl, K., Ory, C., Vanderplas, A., Nicklasson, L., Lyness, W., Cobden, D. & Chang, E. (2007). An evaluation of patient preference for an alternative insulin delivery system compared to standard vial and syringe. Current Medical Research and Opinion, 23(1), 133-146. https://doi.org/10.1185/030079906x159524
  • Sugai, K., Shikuma, J., Hiroike, S., Abe, H. & Suzuki, R. (2023). Successful introduction of sensor‐ augmented pump therapy in a patient with diabetes and needle phobia: A case report. Journal of Diabetes Investigation, 14(11), 1318-1320. https://doi.org/10.1111/jdi.14061
  • Valentini, M., Scardapane, M., Bondanini, F., Bossi, A., Colatrella, A., Girelli, A., Ciucci, A. et al. (2015). Efficacy, safety and acceptability of the new pen needle 33G × 4 mm: AGO 01 study. Current Medical Research and Opinion, 31(3), 487-492. https://doi.org/10.1185/03007995.2014.993025
  • Vlachou, E., Ntikoudi, A., Owens, D. A., Nikolakopoulou, M., Chalimourdas, T. & Cauli, O. (2022). Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: An update review of randomized controlled trials. Journal of Diabetes and Its Complications, 36(5), 108185. https://doi.org/10.1016/j.jdiacomp.2022.108185
  • Wang, W., Men, L., Wang, Y., Shi, C., Yin, H., Li, H., Zhou, H. et al. (2024, May 8). Effect of needle-free injection on psychological insulin resistance and insulin dosage in patients with type 2 diabetes. Frontiers in Endocrinology, 15, 1379830. https://doi.org/10.3389/fendo.2024.1379830
  • Xing, Y., Xie, X., Xu, J., Liu, J., He, Q., Yang, W., Zhang, N. et al. (2019). Efficacy and safety of a needle-free injector in Chinese patients with type 2 diabetes mellitus treated with basal insulin: A multicentre, prospective, randomised, crossover study. Expert Opinion on Drug Delivery, 16(9), 995-1002. https://doi.org/10.1080/17425247.2019.1649251
  • Youngwanichsetha, S. (2021). The effect of online computer assisted instruction on knowledge, self- efficacy, and satisfaction of nursing students. International Journal of Nursing Education, 14(1), 181-185. https://doi.org/10.37506/ijone.v14i1.17772.
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Hemşirelik (Diğer)
Bölüm Araştırma Makalesi
Yazarlar

Mehmet Aygün 0009-0001-6116-2308

Gönderilme Tarihi 29 Mart 2025
Kabul Tarihi 30 Nisan 2025
Yayımlanma Tarihi 26 Ocak 2026
Yayımlandığı Sayı Yıl 2026 Cilt: 4 Sayı: 2

Kaynak Göster

APA Aygün, M. (2026). EFFECT OF NURSING PRACTICES ON FEAR OF INSULIN IN DIABETIC PATIENTS: A SYSTEMATIC REVIEW*. İstanbul Rumeli Üniversitesi Sağlık Bilimleri Dergisi, 4(2), 51-75.