Physical Leisure Activities in Adolescents with Disabilities: Data from National Survey of Disabled Persons.

The impact of activities of daily living (ADLs) on the life satisfaction of adolescents with disabilities and the potential role of physical leisure activities as a moderator in this context have received attention. However, little is known about the influence of physical leisure activities on the relationship between ADLs and life satisfaction in adolescents with disabilities. This cross-sectional study aimed to investigate the moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction among adolescents with disabilities. Secondary data analysis was conducted by extracting data from 5364 adolescents aged 12-18 years with disabilities from the 2020 National Survey of Disabled Persons of Korea. The potential moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction was investigated using Pearson's correlation analysis and hierarchical multiple regression. Significant positive correlations were found for living, life satisfaction, and physical leisure activities. Physical leisure activities were found to play a moderating role in the relationship between ADLs and life satisfaction. This study concluded that increasing physical leisure activities, even with dependent ADLs, promotes life satisfaction, especially if ADLs are low, highlighting the necessity of increasing leisure activities in adolescents with disabilities.

Development of an Acute Pain Assessment Tool for Patients in Post-anesthesia Care Units.

BACKGROUND: Post-operative pain is a common form of acute pain. Objective pain assessment in post-anesthesia care units after surgery is useful regardless of the patient's condition. AIMS: This study aimed to develop and evaluate an acute pain assessment tool for patients in post-anesthesia care units. DESIGN: This was a cross-sectional observational study comprising two stages: scale development and psychometric evaluation. SETTINGS:  . PARTICIPANTS/SUBJECTS:  . METHODS: Scale items were developed based on a literature review and content validity by experts. The validity and interrater reliability of the pain scale were evaluated using data from 218 patients admitted to the post-anesthesia care unit at a university hospital. A receiver operating characteristic curve was used to identify the sensitivity and specificity for determining the cutoff point for acute pain. RESULTS: We developed an objective acute pain scale, called the APA5, which ranges from 0-10 and comprises behavioral (facial and verbal expressions and body movement) and physiological (changes in heart rate and blood pressure) responses. The APA5 is valid and reliable for assessing acute pain in the recovery room. Sensitivity and specificity were acceptable when the cutoff was 2 out of 10 points. CONCLUSIONS: The APA5 is an easy and simple tool for measuring pain in patients in post-anesthesia care units who have difficulties with self-reporting.

Suggestion for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination: a survey-based descriptive study.

PURPOSE: This study aims to suggest the number of test items in each of 8 nursing activity categories of the Korean Nursing Licensing Examination, which comprises 134 activity statements including 275 items. The examination will be able to evaluate the minimum ability that nursing graduates must have to perform their duties. METHODS: Two opinion surveys involving the members of 7 academic societies were conducted from March 19 to May 14, 2021. The survey results were reviewed by members of 4 expert associations from May 21 to June 4, 2021. The results for revised numbers of items in each category were compared with those reported by Tak and his colleagues and the National Council License Examination for Registered Nurses of the United States. RESULTS: Based on 2 opinion surveys and previous studies, the suggestions for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination in this study are as follows: 50 items for management of care and improvement of professionalism, 33 items for safety and infection control, 40 items for management of potential risk, 28 items for basic care, 47 items for physiological integrity and maintenance, 33 items for pharmacological and parenteral therapies, 24 items for psychosocial integrity and maintenance, and 20 items for health promotion and maintenance. Twenty other items related to health and medical laws were not included due to their mandatory status. CONCLUSION: These suggestions for the number of test items for each activity category will be helpful in developing new items for the Korean Nursing Licensing Examination.

High-Tech Home-Based Rehabilitation after Stroke: A Systematic Review and Meta-Analysis.

(1) Background: To improve existing rehabilitation technologies, we conducted a systematic review and meta-analysis to identify the effect size of home-based rehabilitation using robotic, virtual reality, and game devices on physical function for stroke survivors. (2) Methods: Embase, PubMed, Cochrane Library, ProQuest, and CINAHL were used to search the randomized controlled trials that applied technologies via home-based rehabilitation, such as virtual reality, robot-assisted devices, and games. The effect size (Hedges's g) of technology type and affected limb on physical function were calculated. (3) Results: Ten studies were included. The effect size of home-based rehabilitation in virtual reality had the greatest value (Hedges's g, 0.850; 95% CI, 0.314-1.385), followed by robot-assisted devices (Hedges's g, 0.120; 95% CI, 0.003-0.017) and games (Hedges's g, -0.162; 95% CI, -0.036 to -0.534). The effect size was larger in the upper limbs (Hedges's g, 0.287; 95% CI, 0.128-0.447) than in the lower limbs (Hedges's g, -0.113; 95% CI, -0.547 to 0.321). (4) Conclusions: Virtual reality home rehabilitation was highly effective for physical function compared to other rehabilitation technologies. Interventions that consisted of a pre-structured and tailored program applied to the upper limbs were effective for physical function and psychological outcomes.

Health equilibrium in Korean adults with type 2 diabetes mellitus: A hybrid concept analysis.

AIM: The aim of the study was to provide a concept analysis of health equilibrium among patients with diabetes and introduced its operational definition. DESIGN: A concept analysis was conducted using a hybrid model of Schwartz-Barcott and Kim (Nursing research methodology: issues and implementations, Aspen, 1986). METHODS: Using consolidated criteria for reporting qualitative research guidelines, 10 participants with diabetes mellitus were interviewed. Each participant conducted at least two interviews, with each interview session lasting approximately 20-60 min at home or in a quiet place with some privacy. Data were analysed using a grounded theory approach. RESULTS: The health equilibrium concept included four categories with 12 attributes: cognitive (commitment to health, willingness to make life adjustments, balanced awareness, maintaining control), social (social role performance, holding a social support system, participation in social relationships), behavioural (leading a balanced life, making efforts to maintain health, modulating overreaction diabetes) and psychological (hopefulness for a healthy life psychological stability) factors. Thus, health equilibrium was defined as a state in which remain committed to health, while maintaining a stable daily life, social relationships and psychological stability despite prejudices against the disease and self-care experiences. CONCLUSION: Health equilibrium for diabetes patients was defined as maintaining cognitive, social, behavioural and psychological equilibrium as a process of willingly adjusting to life with diabetes. This can help people with diabetes improve self-care and maintain social roles.

Fact Sheet of Amputee 10-Year Trends in Korea: From 2011 to 2020.

This fact sheet was used to analyze the trends in the number of amputees within the population and changes in their health-related behaviors since 2011. Data from the National Survey of Disabled Persons in Korea from 2011 to 2020 were used in this study. The cases of amputation among people with disabilities have increased. Although there were more upper extremity amputations than lower extremity amputations, as amputations below the wrist account for a greater proportion in South Korea than in other countries, the number of upper extremity amputations decreased and lower extremity amputations increased. The most common cause of amputation is accidents, followed by diseases and congenital anomalies. The majority of the amputees were male; however, the number of females showed a gradual increase, and the average age also increased. The proportion of amputated patients with chronic diseases, such as diabetes and hypertension, is increasing, and medical services are relatively limited. In this review study, through the 10-year trend change in the prevalence of amputee, it was possible to infer the impact of personal, social, and environmental changes. Based on these amputee statistics, it is expected that they can be used to plan health and medical policies for the disabled.

Multimodal Diabetes Empowerment for Older Adults with Diabetes.

Systematically improving empowerment is not easy when operating a diabetes program for older adults. This study aimed to develop and test the feasibility of the diabetes empowerment (Dia-Empower) program for older adults with type 2 diabetes. A non-randomized controlled study with a matched sampling design was conducted. Community-dwelling older adults with diabetes were allocated to either the Dia-Empower program group or a control group. Changes in the primary (diabetes self-care and empowerment) and secondary outcomes (body composition and physical function) were compared between the groups. The scores for diabetes self-care and empowerment were significantly higher in the experimental group than in the control group. Changes in skeletal muscle mass and body fat ratio were significantly different between the groups. Handgrip strength and shoulder flexibility positively changed in the experimental group. The Dia-Empower program was feasible for older adults with diabetes in the community. In the future, it is necessary to study the long-term effects of the program and its effects on blood sugar control.

Adaptive behavior in stroke survivors: A concept analysis.

PURPOSE: This study aims to explore a clear and evidence-based definition of adaptive behavior in stroke survivors and establish the antecedents, attributes, consequences, and empirical referents of the concept. METHODS: The concept analysis was performed using the Walker and Avant methods as a framework. Data from 90 publications were collected using various databases (PubMed, EMBASE, CINAHL, RISS, and KISS) and applied in the analysis. RESULTS: Adaptive behavior in stroke survivors was defined according to four attributes: realizing change, taking an optimistic view, restructuring daily activities to suit oneself, and carrying out one's own daily life. The conceptual structure of their adaptive behavior comprised stroke onset, functional changes, and emotional liability as antecedents and autonomy, family equilibrium, and quality of life as consequences. CONCLUSIONS: Clarifying the concept of adaptive behavior in stroke survivors provides an understanding of the underlying attributes of this concept. Furthermore, it will facilitate the development of scales to measure the concept and the application of a theory-based intervention program that can improve adaptive behavior.

Do Adults Who Practice Aerobic Physical Activities Have Different Influencing Factors for Depression: A Secondary Data Analysis.

Practice in aerobic activities can positively impact depression. This study aimed to identify differences between adults who do and do not practice aerobic activities in terms of general, physical, and psychological factors that influence depression. This study comprised a secondary analysis of data from the 6th (year 2) and 7th (years 1, 3) editions of the Korea National Health and Nutrition Examination Survey. Data from 12,891 adults were analyzed, of whom 7148 reported no practice in aerobic physical activities and 5743 reported practicing such activities. Data were analyzed using SPSS 25. Among those who did not perform aerobic activities, gender, family income, marital status, obesity, frequency of drinking, subjective health, subjective body weight, and stress were found to influence the level of depression. For those who practiced aerobic activities, gender, age, family income, education level, marital status, blood pressure, hypercholesterolemia status, frequency of drinking, subjective health, subjective body weight, and stress influenced the level of depression. This study found that the factors affecting depressive symptoms differ depending on whether individuals practice aerobic activities. Thus, to reduce depressive symptoms among adults, it is necessary to consider their level of physical activity and target the influencing factors associated with this level.

Related Factors for Impaired Fasting Glucose in Korean Adults: A Population Based Study.

BACKGROUND: Individuals with impaired fasting glucose (IFG) who have poor health behaviors are at a greater risk for various health outcomes. This study compared the health behaviors and health literacy between individuals with non-IFG and IFG; factors that were associated with IFG were identified by sex. METHODS: This study was an observational study with a cross-sectional design based on data from the Korea National Health and Nutrition Examination Survey (KNHANES) that used a stratified, multi-stage, cluster-sampling design to obtain a nationally representative sample. This study analyzed the KNHANES Health Examination Survey and Health Behavior Survey from 2016 to 2018 (N=9919). Multiple logistic regression analysis was employed to compute the odds ratios of health behaviors and health literacy to identify the risk factors for IFG. RESULTS: The prevalence of IFG among the total was 29.0% (weighted n=2826, 95% CI 27.8-30.2). In the IFG group, 63.6% were male and 36.4% were female (X2=320.57, p<.001). In multiple logistic regression by sex, the factors associated with IFG in male were as follows: age (50s; OR=2.36, 95% CI 1.79-3.13), high BMI (OR=2.27, 95% CI 1.78-2.90), frequent drinking (OR=1.83, 95% CI 1.23-2.72), and using nutrition fact labels (OR=1.35, 95% CI 1.05-1.75). Low economic status (OR=4.18, 95% CI 1.57-11.15) and high BMI (OR=2.35, 95% CI 1.29-4.28) were the affecting factors in female. On the other hand, employment status, perceived stress, and job type were not related to IFG in both male and female. CONCLUSIONS: Strategies should be targeted to improve health behaviors and health literacy for those in their 40s and 60s, male in shift work, those who frequently dine out, overweight male, female with low economic statuses, and frequent drinkers. Moreover, healthcare providers should understand the barriers to health behaviors and literacy to effectively deliver healthcare service.

Development and validation of the self-stigma scale in people with diabetes.

AIM: To develop and initially validate the Diabetes Self-Stigma Scale for assessing self-stigma in people with diabetes. DESIGN: Scale development and evaluation. METHODS: Participants were 399 patients with diabetes. In phase 1, initial items were generated based on the concept analysis of diabetes self-stigma. Moreover, content validity was established by diabetes experts. Phase 2 evaluated structural validity through item analysis, exploratory factor analysis and confirmatory factor analysis. Reliability was evaluated by examining stability and internal consistency. RESULTS: The findings revealed that the self-stigma scale for patients with diabetes is a valid and reliable instrument. The Diabetes Self-Stigma Scale was confirmed with 16 items. It consists of four domains: comparative inability, social withdrawal, self-devaluation and apprehensive feeling. The scale developed in this study can measure self-stigma in diabetes patients and can be used as an intervention to reduce self-stigma.

Korean Translation and Psychometric Evaluation of Korean Version EORTC QLQ-BRECON23.

The purpose of this study was to evaluate the psychometric properties of the Korean version of the European Organization for Research and Treatment of Cancer Quality of Life-QLQ-BRECON23 in women diagnosed and treated for breast cancer undergoing all types of breast reconstruction. METHODS: A total of 148 Korean women who underwent breast reconstruction were recruited from the breast cancer center to participate in the study. After performing forward and backward translation of the original English version of the questionnaire into Korean, its validity (construct, known-group validity, concurrent) and reliability were assessed. A structural equation model (SEM) was used to assess construct validity. RESULTS: The mean age of the patients was 52 years, and 89.8% underwent implant-based reconstruction. Construct validity using confirmatory factor analysis showed a good fit, and the effect size was small-to-medium regarding known-group validity. Concurrent validity was confirmed by the significant correlation between the QLQ-BRECON23 and the QLQ-BR23. The reliability of the QLQ-BRECON23 symptom and function scales ranged from 0.61 to 0.87. CONCLUSION: The Korean QLQ-BRECON23 can be applied to assess quality of life and its related factors, and also to internationally compare the level of quality of life in breast cancer patients undergoing breast reconstruction.

Dynamic body posture after unilateral mastectomy: a pilot study.

BACKGROUND: Postural changes after unilateral mastectomy may appear in relation to the dominant hand, postoperative duration, and dynamic conditions. This study aimed to compare the postural changes by inclination angles and muscle activities in the static and dynamic sitting position between women with breast cancer who underwent mastectomy and women who did not have breast cancer. METHODS: The observational study design was conducted. We evaluated 17 women who underwent modified radical mastectomy (MRM) more than 1 year prior to the study. They were categorized into the Rt. mastectomy group (n=7) and the Lt. mastectomy group (n=10). An aged-matched cohort of 8 healthy females was also included. The inclination angle in both static and dynamic sitting positions was measured using the balance board system (BBS), and the muscle activities of 8 muscles were measured in the dynamic sitting position. RESULTS: There was no significant difference in demographic characteristics between the patients, and all patients were right-handed. The inclination angle of the anterior-posterior axis when leaning forward was significantly increased to the anterior side in the Rt. mastectomy group than in the Lt. mastectomy group. Meanwhile, the inclination angle in the static sitting position and when tilted backward to both directions did not differ among the 3 groups. The inclination angle of the right-left axis was statistically increased to the left side during tilting anterior-left direction in the Rt. Mastectomy group. The muscle activities of the thoracic erector spinae were significantly lower when tilted backward in the Rt. mastectomy group than in the Lt. mastectomy group. CONCLUSIONS: Compared with left mastectomy, right unilateral mastectomy yielded more postural changes under dynamic sitting state in right-handed female patients with breast cancer. Thus, to maintain the trunk balance and prevent the postural changes after unilateral mastectomy, the postoperative exercise programs for the para-thoracic muscles will be helpful.

The role of psychological insulin resistance in diabetes self-care management.

Aims: The purpose of this study was to identify the role of psychological insulin resistance in the relationship between diabetes self-efficacy and diabetes self-care management in people with diabetes over 65 years of age. Design: A descriptive, cross-sectional design was used. Methods: Participants included 326 patients with type 2 diabetes who were over 65 years of age. Structural equation modelling was performed to estimate the direct and indirect effects of diabetes self-efficacy on diabetes self-care management when psychological insulin resistance was entered as a mediator. Data were collected from May 2015 to January 2017. Results: Diabetes self-efficacy (r = .53, p < .001) and psychological insulin resistance (r = .33, p < .001) were significantly associated with diabetes self-care management, whereas a negative association was found between diabetes self-efficacy and psychological insulin resistance (r = -.16, p < .001). When psychological insulin resistance was entered as a mediator, the association between diabetes self-efficacy and diabetes self-care management was attenuated. Therefore, psychological insulin resistance served as a mediator of diabetes self-care management.

Distorted body weight perception and its gender differences in middle-aged adults: population based study.

BACKGROUND: Increasing interest in appearance and the growing preference for a beautiful body can lead to physical and psychological problems due to an inappropriate body image perception. As such, there is a need to identify what factors may contribute to an inappropriate body image. The purpose of this study was to examine the presence of distorted body weight perception among middle-aged Koreans and identify gender differences and other factors that contribute to a distorted body image regarding body weight. METHODS: Data on 8363 middle-aged adults (aged 45-64 years) from the Korea National Health and Nutrition Examination Survey were analyzed using complex samples analysis considering weight, stratification variables, and cluster variables. The difference between perceived body image regarding body weight and actual body mass index was used to assess distorted body weight perception. Socioeconomic status, health behaviors, daily energy consumption, and psychological status (depression and stress) were assessed for their relationship to distorted body weight perception. RESULTS: Results showed that a distorted body image regarding body weight was more prevalent among middle-aged men (45.3%) than women (25.7%). Age, income, perceived health status, and health behaviors were significantly associated with distorted body weight perception in middle-aged men, whereas psychological factors were associated with distorted body weight perception in middle-aged women. CONCLUSIONS: Further research on distorted body weight perception is needed to gain understanding of the gender differences between middle-aged men and women in Korea. Furthermore, to the results of the study can be used as a basis for developing various education, health mediation, and public health promotion interventions and programs to address body weight perception in middle-aged adults.

An Item Response Theory Analysis of the Korean Version of the CRAFFT Scale for Alcohol Use Among Adolescents in Korea.

PURPOSE: This study aimed to validate the psychometric properties of the CRAFFT (Car, Relax, Alone, Forget, Family/Friends, Trouble) by using item response theory (IRT) and further examine gender differences in item-level responses. METHODS: This study used the 13th (2017) Korea Youth Risk Behavior Survey data conducted by the Korean Centers for Disease and Prevention and analyzed data of 8,568 students who reported drinking alcohol in the previous 30 days. IRT assumptions including unidimensionality, local independence, and monotonicity were tested. A one-factor two-parameter IRT model was fitted for item parameterization (M2 = 76.92, 20 df, p < .001, root mean square error of approximation = 0.02). Graphics for item characteristic curves and item and test information curves were provided. Differential item functioning (DIF) analysis was evaluated to measure item equivalence between boys and girls. RESULTS: Unidimensionality and local independence were satisfied, and the dominant factor eigenvalue and variance were 2.48 and 41.3% in boys and 2.08 and 34.7% in girls, respectively, and residual correlations in paired items were less than .2. The discrimination parameters were estimated as 1.32-3.59 for boys and 1.30-3.64 for girls. The severity parameters estimated verity as -0.23 to 1.67 for boys and -0.32 to 2.17 for girls. DIF was detected for four of six items, "Car," "Relax," "Forget," and "Family/friends." However, its impact on the total score was negligible. CONCLUSION: The CRAFFT is a valid and reliable screening tool to identify alcohol use problems for both boys and girls, exhibiting good discrimination, good coverage of severity, and negligible DIF.

Effects of formulation types on pharmacodynamics of warfarin in patients with cerebral infarction and dysphagia.

PURPOSE: The purpose of this study was to investigate the effects of the type of formulation on the efficacy of warfarin. MATERIALS AND METHODS: The electronic medical records of patients with cerebral infarction, who were administered tablet or powder formulations of warfarin from 2013-2015, were retrospectively analyzed. Clinical data, changes in the international normalized ratio (INR), the warfarin dose, and the time to reach the plasma warfarin concentration that could induce an adverse effect, such as bleeding, were evaluated. Coefficients of variation of INR and of the warfarin dose, as well as the warfarin sensitivity index (WSI), were used to evaluate the INR stability. Statistical analysis of the data was performed using a independent t-test. Additionally, survival analysis was performed. RESULTS: The data showed that 57 and 137 patients were administered warfarin as powder and tablet formulations, respectively. We noted that INR, WSI, and INR/dose × body weight differed significantly between the two groups of patients. The median survival times to reach the plasma warfarin concentration that could induce adverse effects were 3.6 and 4.2 days of treatment with the powder and tablet formulations, respectively. The efficacy of warfarin was higher when the drug was administered as a powder than when it was administered as a tablet. CONCLUSION: The findings of this study indicate that INR should be carefully monitored in the first 4 days of warfarin administration as a powder formulation.

Predictors of happiness among older Korean women living alone.

AIM: The level of happiness of older adults is associated with their psychosocial and physical health. Currently, little is known about the predictors of happiness among older women living alone in the community. The present study aimed to identify these predictors. METHODS: This was a cross-sectional descriptive study of older women who were living alone and were registered with a social welfare center in an old urban area in South Korea. We designated various demographic factors along with health-related information, perceived self-esteem and depressive symptoms as independent variables predicting happiness. Descriptive statistics and multivariate analysis were carried out. RESULTS: In total, 154 participants were recruited. They showed a moderate level of happiness. Furthermore, happiness was negatively correlated with the number of comorbidities, presence of pain and depressive symptoms, but positively correlated with self-esteem. The final model in hierarchical regression showed that depressive symptoms were powerful predictors of happiness after controlling the covariates and accounted for approximately 76.7% of the total variances. CONCLUSIONS: The happiness of older women living alone was associated with their self-esteem and depressive symptoms. Interventions aimed at reducing depressive symptoms and improving self-esteem should be developed and applied to this population. Geriatr Gerontol Int 2019; 19: 352-356.

Self-stigma among Korean patients with diabetes: A concept analysis.

AIMS AND OBJECTIVES: To conduct a concept analysis of self-stigma among patients with diabetes and introduce an operational definition of self-stigma. BACKGROUND: Due to fears of being monitored, patients with diabetes often conceal their disease and/or withdraw from social relationships. These behaviours negatively affect patients' self-care and socialisation. DESIGN: A concept analysis was conducted using a three-phase (theoretical phase, fieldwork phase and final analysis phase) hybrid method by Schwartz-Barcott and Kim (Nursing research methodology: Issues and implementations, 1986, Rockville, MD: Aspen). METHODS: During the theoretical phase, a literature search was conducted using PubMed and CINAHL. Using COREQ guidelines, in the fieldwork phase, in-depth interviews were conducted with nine participants with diabetes. The recorded data were analysed using a grounded theory approach. Results from both were included in the analytic phase. RESULTS: In the fieldwork phase, nine patients with diabetes (four men and five women; mean age = 57.00 ± 21.93 years) participated in the interview. The mean duration of diabetes was 21.44 ± 12.39 years. The self-stigma concept included three categories with nine attributes: affective (negative feelings and feeling sorry for others who have concerns about me), cognitive (low self-esteem and self-efficacy, perceived weakness, low expectations for the future, worry for children and disease burden) and behavioural factors (social withdrawal and avoiding disease disclosure). The nine attributes included 23 indicators. CONCLUSIONS: Self-stigma among patients with diabetes is defined as a state in which patients develop negative self-feelings as they deal with the disease. This can cause diminished self-esteem and self-efficacy, as well as a tendency to avoid disclosing the illness along with social withdrawal. RELEVANCE TO CLINICAL PRACTICE: Based on this self-stigma concept analysis, we clarified the attributes of diabetes self-stigma and distinguished it from social stigma in nurse professionals during patient education and clinical assessment.

The prevalence of insulin refusal and psychological insulin resistance among Korean patients with type 2 diabetes mellitus.

BACKGROUND: This study investigated the prevalence of insulin refusal and compared the level of psychological insulin resistance (PIR) with the intention to accept insulin therapy among Korean patients with type 2 diabetes. METHODS: Type 2 diabetes patients (n=1,209) were recruited from inner city outpatient diabetes clinics in 2016. Patient demographic, insulin recommendation, diabetes treatment type, intention to receive insulin therapy, and PIR information was collected using self-reports. The patients were divided into three groups: those who refused insulin therapy (n=184), those who accepted insulin therapy (n=331), and those not recommended for insulin therapy (n=694). Descriptive statistics were used to calculate the prevalence of insulin refusal; t-tests and analyses of variance were used to compare demographics with PIR. RESULTS: The insulin refusal rate was 35.7%. The duration of diabetes, numbers of diabetes-related complications, and glycated hemoglobin levels were significantly lower in the group not recommended for insulin therapy than refused and accepted insulin groups. The level of PIR in insulin refusal group was significantly lower among patients agreeing to receive insulin therapy within 3 months than among those refusing insulin therapy. CONCLUSIONS: The prevalence of insulin refusal in Korea is not low, and people who refuse insulin therapy have high levels of PIR. Strategies to reduce PIR levels are needed.