Patient and Health Care Provider Experiences of Suboptimal Insulin Dosing in the United States

Objectives: This study described the frequency of suboptimal insulin dosing (missed and mistimed doses) and the factors underlying this behavior from the perspective of people with diabetes (PwD) and healthcare professionals (HCPs.) Methods: For this cross-sectional, multinational non-interventional study, 640 HCPs and 1150 PwD (300 with type 1 diabetes, 850 with type 2 diabetes) completed an online survey. A research vendor recruited adult PwD currently using a non-connected insulin pen (400 from US) and eligible HCPs (160 from US) via validated panels, referrals, list acquisition, and custom methods. Results are presented for US data. Results: Overall, 42% and 61% of PwD reported missing basal and bolus insulin doses in the past 30 days. The average number of missed basal and bolus doses were 3.1 (SD=3.81) and 5.0 (SD=10.30), respectively. PwD reported forgetting, being too busy/distracted, and out of my normal routine as key reasons for missed doses. Overall, 37% and 49% of PwD reported mistiming basal and bolus doses, respectively, in the past 30 days. This corresponded to an average of 3.1 (SD=3.29) mistimed basal and 4.9 (SD=6.28) mistimed bolus doses. Key reasons PwD reported for mistimed doses included being too busy/distracted, forgot or having an unexpected or earlier/later-than-expected meal. Conversely, the majority of HCPs reported ≤20% of their PwD missed/skipped a dose in the past 30 days. HCPs reported dosing reminders (90%), automatically recorded insulin doses and timing (92%) and having insulin and glucose data in one place (94%) as identified solutions. Conclusions: PwD are missing, skipping, or delaying their insulin doses, largely for preventable reasons. HCPs perceive PwD dosing adherence greater than PwD self-reported behaviors. Digital health solutions, such as connected insulin pens, may help PwD reduce missed and mistimed doses as well as help close the perception gap to further optimize insulin management. Disclosure M.B.Davidson: Employee; Eli Lilly and Company. F.Gelsey: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. J.Bower: None. E.Artime: None. E.Spaepen: Consultant; Eli Lilly and Company. R.Newson: Employee; Eli Lilly and Company. Funding Eli Lilly and Company