Factors Influencing Psychological Insulin Resistance Among Patients with Type 2 Diabetes in China: A Structural Equation Model Analysis

Purpose: Psychological insulin resistance (PIR) seriously impairs compliance and satisfaction with insulin therapy in patients with type 2 diabetes (T2D). This study aimed to build a structural equation model (SEM) to investigate factors influencing PIR in patients with T2D and the interactions between them. Patients and Methods: A cross-sectional study was conducted with 289 patients with T2D at the endocrinology department of the First Affiliated Hospital of Anhui Medical University in China between March and September 2023. Demographic characteristics, self-efficacy (SE), social support (SS), diabetes distress (DD), diabetes stigma (DS), and PIR were evaluated using questionnaires, and the pathways were validated by SEM. Results: The participants had an average PIR score of 56.74 (standard deviation: 11.44). The final model fit well (CMIN/DF = 1.564, GFI = 0.960, AGFI = 0.933, RMSEA = 0.044, NFI = 0.948, TLI = 0.972, IFI = 0.981, CFI = 0.980). In patients with T2D, SE (β = − 0.610, P < 0.001), DD (β = 0.613, P < 0.01), SS (β = − 0.386, P = 0.001), and DS (β = 0.284, P = 0.001) were significantly associated with PIR. Conclusion: The PIR scores of patients with T2D were moderate in this study. PIR was linked to SE, SS, DD, and DS in patients with T2D. Among T2D patients, greater SE and lower DD were linked to lower PIR. The direct and indirect correlations between the structural variables in this study offer a good basis for the creation of focused interventions that lower PIR levels.