Associations of psychological insulin resistance, diabetes-related stress, and intention to use complementary and alternative diets with self-management among older adults with type 2 diabetes: A cross-sectional study

PURPOSE: This study investigated the associations of psychological insulin resistance (PIR), diabetes- related stress, and intention to use complementary and alternative diets (CAD) with self-management in older adults with type 2 diabetes. METHODS: A cross-sectional study was conducted with 180 adults aged ≥65 with type 2 diabetes at a primary clinic in Korea. Data were collected using structured questionnaires between March and June, 2024. SPSS was used for descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation, and multiple regression analysis. RESULTS: The average age of participants was 73.79±5.59 years. PIR (mean, 57.54±8.81), diabetes-related stress (mean, 41.62±7.65), intention to use CAD (mean, 3.56±1.32), and self-management (mean, 38.11±5.98) were measured. The PIR was positively correlated with self-management (r=.31, p<.001), whereas diabetes-related stress was negatively correlated with self-management (r=-.24, p<.001). PIR (β=.47, p<.001) and diabetes-related stress (β=-.41, p<.001) were significant predictors of self-management (R2=24.6%). CONCLUSION: PIR positively correlated with self-management and was the most influential factor, suggesting that resistance to insulin treatment may paradoxically motivate individuals to engage in better self-management behaviors. Intention to use CAD was weakly positively correlated with PIR, indicating that individuals with higher insulin resistance may explore alternative dietary options. Diabetes-related stress negatively affects self-management, highlighting the importance of stress management for improving diabetes self-management. These findings highlight the significance of psychological factors in the development of tailored self-management education programs for older adults with type 2 diabetes.