INS and major depressive disorder: Other factors are either difficult to modify, such as certain affect psychosocial factors (e.g., diabetes emotional distress, depression, anxiety, etc.)[14, 19, 30, 35] or partly unmodifiable such as medication regimen factors including the complexity of insulin regimen [5, 13, 36], type of administration devices [4, 14, 27], and insulin side effects (e.g., hypoglycemia).