Timing of Insulin Injections, Adherence, and Glycemic Control in a Multinational Sample of People with Type 2 Diabetes: A Cross-Sectional Analysis

Abstract

IntroductionWe investigated the association of bolus insulin dose timing with demographics, adherence, diabetes education program participation, experience with hypoglycemic events, glycemic control, and patient preference among respondents with type 2 diabetes.MethodsAdults with type 2 diabetes from 12 countries were recruited to a Web-based self-reported patient preference survey. Adherence was measured using an adapted Morisky Medication Adherence Scale questionnaire.ResultsIn total 1483 respondents reported using bolus insulin with 58% (n = 864) dosing bolus insulin before meals (pre-meal cohort), 354 (24%) during or after meals (post-meal cohort), and 265 (18%) before, during, or after meals (mixed cohort). The mixed cohort was excluded, thus 1218 respondents were included in the analysis. Respondent distribution across HbA1c category differed significantly depending on insulin dose timing (p = 0.0006); more respondents in the post-meal cohort (40%) had HbA1c ≥ 9% (74.9 mmol/mol) than in the pre-meal cohort (29%). The post-meal cohort was significantly more likely to report non-adherence than the pre-meal cohort (OR = 1.50, p = 0.01) and significantly more often reported participating in diabetes education programs (p < 0.05). Seventy-eight percent of all respondents reported preferring bolus insulin administrable whenever convenient.ConclusionsApproximately 24% of respondents never comply with guidelines for insulin dose timing, with higher risk of non-adherence and increased participation in diabetes care programs. Respondents dosing insulin post-meal are more likely to have poor glycemic control (HbA1c ≥ 9%, 74.9 mmol/mol). Given that many respondents had high HbA1c and were non-adherent, a treatment which satisfies patient preference for bolus insulin with flexible dose timing could be considered.FundingNovo Nordisk.

Fast-Acting Insulin Aspart and the Need for New Mealtime Insulin Analogues in Adults With Type 1 and Type 2 Diabetes: A Canadian Perspective

“…However, in daily life, patients struggle to adhere to recommended injection-to-meal intervals and many use only very short premeal intervals or none at all or inject bolus insulin postmeal. A recent survey of patients with type 2 diabetes receiving bolus insulin across North America, South America and Europe highlighted that 24% never comply with guidelines for the timing of insulin dosing (24). In a second survey of patients with type 1 or type 2 diabetes, 18.9% reported bolus dosing postmeal in the previous week, while 12.7% reported dosing with meals, and 11.5% reported dosing at varying times (25).…”

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

“…[1][2][3][4] Difficulties with insulin dosing and inaccurate dose timing have been shown to result in poor glycemic control for people with diabetes. 5,6 The impact of missed insulin injections on HbA 1c levels is well established, [7][8][9][10][11][12] leading to an increasing risk of diabetes-related complications. 13,14 Technological advances offer opportunities to optimize insulin delivery, reduce dosing errors, and improve regimen management.…”

Injectable therapy in type 2 diabetes mellitus: strategies to improve therapeutic adherence

“…Очевидно, что весьма значимыми причинами низкой приверженности является необходимость выполнять рекомендации и по учету углеводов в пище, соблюдению времени введения инсулина, проведению регулярного самоконтроля, что выполняется крайне неудовлетворительно. Например, в исследовании 1483 пациентов с СД2 только 58% вводили короткий инсулин до еды [32]. Лишь незначительная доля пациентов оказалась способна проводить учет углеводов в пище [33].…”

“…Однако в 2018 г. очередная попытка ответить на вопрос, почему пациенты не следуют рекомендациям, пришла к выводу, что основной причиной является низкий уровень мотивации пациентов, даже несмотря на то, что их уровень знаний мог быть достаточным [72]. Наряду с этим имеются исследования, демонстрирующие отсутствие взаимосвязи между количеством пройденных курсов обучения и приверженностью пациентов лечению [77].…”