1 in 4 Patients with Type 2 Diabetes Does Not Take Basal Insulin as Prescribed

In addition to skipping doses, many patients self-treat a hypoglycemic event
Value-Based Care in Cardiometabolic Health August 2012, Vol 1, No 2
Wayne Kuznar

Among patients with type 2 diabetes, 1 in 4 patients did not take the prescribed doses of basal insulin correctly in the past 30 days, and more than 33% of the patients treated themselves for hypoglycemia, according to the results of the Global Attitudes of Patients and Physicians (GAPP2) survey.

“Despite clinical awareness of hypoglycemia and dosing irregularities, type 2 diabetes patients using insulin analogs still need further support to improve medication-taking behavior and reduce rates of self-treated hypoglycemia,” said Meryl Brod, PhD, President of the Brod Group, a health outcomes and phase 4 strategic planning consultancy in Mill Valley, CA, who reported the study results at the 2012 ADA annual meeting.

The study included data on the frequency and effect of basal insulin–taking behavior and hypoglycemia from 3042 patients with type 2 diabetes who use insulin analogs and 1653 healthcare professionals (primary care physicians, diabetes specialists, and diabetes nurses and educators).

The GAPP2 was an online survey conducted in 6 countries (United States, Canada, Japan, Germany, United Kingdom, and Denmark) between January 2012 and March 2012. The results showed that dosing irregularities were common.

As many as 22% of the surveyed patients reported missing taking a basal insulin dose (mean, 3 times) in the past 30 days, 24% took their prescribed basal insulin more than 2 hours before or after the scheduled time (mean, 4 times), and 14% reduced the prescribed dose (mean, 4.2 times). Of these patients, 39% worried when they missed an insulin dose and 37% felt guilty about missing a dose.

By contrast, 48% of the patients said that they never missed a dose, 51% took a dose more than 2 hours later than prescribed, 38% reduced a dose, and 80% self-treated for a hypoglycemic event; within the past year, these percentages were 10%, 10%, 9%, and 16%, respectively.

A correlation was seen between hypoglycemia and dosing irregularities. Significantly more patients who missed a basal insulin injection in the previous 30 days reported a hypoglycemic event (41%) compared with those who did not (34%). Overall, 36% of the patients reported a hypoglycemic event in the past 30 days. Hypoglycemic events were nocturnal in 26% of the patients; 42% of patients worried about nocturnal events compared with 23% of patients who worried about daytime hypoglycemic events.

Although 74% of the healthcare professionals surveyed said that they routinely discuss basal insulin dosing irregularities with their patients, including hypoglycemic events, only approximately 33% of the healthcare professionals reported always discussing these events with their patients who were taking basal insulin only (27%) or basal-bolus (37%).

The researchers concluded that injection nonadherence and self-treated hypoglycemia are continued management challenges in insulin-treated patients with type 2 diabetes. Patient support should focus on interventions that address both the reasons for poor regular insulin-taking and the risk entailed by self-management of hypoglycemia “given the link between these 2 issues,” according to Dr Brod.

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Last modified: September 26, 2012
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