Abstract
BACKGROUND: Diabetes, particularly type 2 diabetes, is a significant global health issue, with insulin therapy being crucial for glycemic control. Psychological insulin resistance (PIR) often hinders effective treatment, impacting treatment outcomes and patient quality of life. OBJECTIVE: This systematic review and meta-analysis aimed to comprehensively analyze the influencing factors of PIR among patients with type 2 diabetes, providing insights for developing targeted interventions to enhance insulin therapy acceptance and improve diabetes management. METHODS: Following PRISMA guidelines, we conducted a systematic search across multiple databases, including PubMed, the Cochrane library, CINAHL, Embase, APA PsycInfo, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and Sinomed, from inception to July 2025. Studies were included if they focused on type 2 diabetes patients and PIR, with exclusion of non-original research and republished literature. Quality assessment was performed using Newcastle-Ottawa Scale for cohort and case-control studies, and AHRQ standards for cross-sectional studies. RESULTS: A total of 22 studies involving 5,965 patients were included. The prevalence of PIR ranged from 27.1 to 82.9%. Meta-analysis indicated that female gender (OR = 0.38, 95% CI: 0.20-0.72, P = 0.003), lack of diabetes education (OR = 1.85, 95% CI: 1.37-2.49, P < 0.0001), and negative attitudes toward insulin (OR = 1.36, 95% CI: 1.17-1.57, P < 0.0001) were significant predictors of PIR. Factors influencing PIR were categorized into five themes: patient characteristics, treatment history, patient attitudes, lifestyle and economic factors, and social-psychological factors. CONCLUSIONS: Understanding the multifaceted nature of PIR is essential for improving glycemic control and patient outcomes. This review provides valuable insights for healthcare providers and researchers, guiding the development of tailored interventions to address PIR and enhance diabetes management. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-025-01714-5.