Insulin Use During, After Meals Raises Risk of Non-Adherence

Individuals with type 2 diabetes who use bolus insulin during or after meals have a greater risk of non-adherence and poorer glycemic control than those who use insulin prior to meals, according to a recent analysis.

For their analysis, the researchers evaluated 1483 adult participants with type 2 diabetes from 12 countries in a web-based, self-reported, patient-preference survey. All patients included in the study had reported bolus insulin use.
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The Morisky Medication Adherence Scale questionnaire was used to measure adherence.

A total of 864 (58%) participants had reported dosing bolus insulin before meals (pre-meal group), 354 (24%) during or after meals (post-meal group), and 265 (18%) before, during, or after meals (mixed group). Only participants in the pre-meal and post-meal groups (n = 1218) were included in the present analysis.

Results indicated that hemoglobin A_1c (HbA_1c) levels varied significantly based on the timing of insulin doses. In the post-meal group, 40% of participants had an HbA_1c of 9% of higher, compared with 29% of participants in the pre-meal group.

Ultimately, the researchers found that participants who used bolus insulin during or after meals were significantly more likely to report non-adherence vs those who used insulin before meals. Furthermore, participants who used insulin during or after meals more often reported participating in diabetes education programs.

The researchers also noted that 78% of all participants had reported preferring bolus insulin “administrable whenever convenient.”

“Approximately 24% of respondents never comply with guidelines for insulin dose timing, with higher risk of non-adherence and increased participation in diabetes care programs,” the researchers concluded.

“Respondents dosing insulin post-meal are more likely to have poor glycemic control (HbA_1c [of 9% or more], 74.9 mmol/mol). Given that many respondents had high HbA_1c and were non-adherent, a treatment [that] satisfies patient preference for bolus insulin with flexible dose timing could be considered.”

—Christina Vogt

Reference:

Schaper NC, Nikolajsen A, Sandberg A, Buchs S, Bøgelund M. Timing of insulin injections, adherence, and glycemic control in a multinational sample of people with type 2 diabetes: a cross-sectional analysis [Published online October 23, 2017]. Diabetes Ther. https://doi.org/10.1007/s13300-017-0317-9.