“Time-specific” dosing of insulin can be an obstacle to adherence for patients with complicated, busy lives. More than half of patients with type 2 diabetes do not achieve their target HbA 1c of 7% after insulin is added to their treatment regimen. Researchers from CAPHRI School for Public Health and Primary Care, and CARIM Institute in The Netherlands, who surveyed 1,483 adults with diabetes suggest that it may be time to rethink both prescribing and patient education, in part because of who fell into the nonadherent group.
The researchers conducted a web-based self-report survey. Of the respondents, 58% used bolus insulin before meals, 24% after meals, and 18% before, during, or after meals. The researchers excluded the “mixed” cohort, including 1,218 in the analysis.
Half the respondents in the postmeal cohort reported experiencing minor hypoglycemic events at least once a week compared with 35% of the premeal cohort. Similarly, more in the postmeal group had had major hypoglycemic events (38% vs 26%). The postmeal respondents also were more likely to have HbA 1c ≥ 9% (40% vs 29%). And they were less likely to report always testing their blood glucose before injecting insulin (36% vs 54%).
Perhaps contrary to some expectations, the respondents who injected insulin postmeal were younger, had shorter duration of diabetes, had the highest level of college or university education, were more likely to be employed, and more frequently participated in diabetes education programs (including one-on-one programs).
The researchers say those data suggest that factors other than lack of diabetes education, education, or low socioeconomic status should be considered in explaining the nonadherence. They add that some research has shown that education programs have an “inconsistent relationship with patient adherence.” They suggest that such programs might be improved by placing greater emphasis on the importance of dosing insulin before meals.
Of the nearly 20% of patients who use insulin treatment, > 90% receive bolus insulin. The researchers note that respondents preferred a form of bolus insulin they can administer before, after, or during meals as they see fit. The respondents who injected postmeal were more likely than the premeal respondents to prefer this formulation.