PIR remains a major barrier to timely insulin initiation in adults with T2DM. Diabetes, Metabolic Syndrome and Obesity reported a cross-sectional analysis using SEM to identify psychosocial pathways influencing PIR.

The study included 289 adults with T2DM who attended the endocrinology department of the First AffiliatedHospital of Anhui Medical University between March and September 2023. Standardized questionnaires assessed SE, social support SS, DD, DS and PIR. Model performance showed strong fit, with a CMIN/DF of 1.564, goodness-of-fit index (GFI) of 0.960 and root mean square error of approximation (RMSEA) of 0.044.

Mean PIR measured 56.74 with a standard deviation of 11.44. SEM found that lower SE (β = −0.610, P<0.001) and lower SS (β = −0.386, P=0.001) were associated with higher PIR. Higher DD (β = 0.613, P<0.01) and higher DS (β = 0.284, P=0.001) were also linked to increased PIR.

The findings indicated that PIR reflects interconnected behavioral and emotional factors. Addressing DD, DS, SE and SS may help reduce PIR and improve acceptance of insulin therapy.