Understanding Suboptimal Insulin Use in Type 1 and 2 Diabetes: A Cross-sectional Survey of Healthcare Providers who Treat People With Diabetes

Abstract

Abstract Background: The purpose of this study was to understand the healthcare provider (HCP) perspective on the extent of suboptimal insulin dosing in people with diabetes (PwD), as well as specific challenges and solutions to insulin management. Methods: An online survey of general practitioners and specialists (N=640) who treat people with diabetes in Germany, Spain, the United Kingdom, and the United States was conducted. Responses regarding HCP background and their patients, HCP perceptions of suboptimal insulin use, and challenges associated with optimal insulin use were collected. Categorical summary statistics were presented. Results:Overall, for type 1 diabetes (T1D) and type 2 diabetes (T2D), most physicians indicated <30% of PwD missed or skipped a bolus insulin dose in the last 30 days (T1D: 83.0%; T2D: 74.1%). The top 3 reasons (other than skipping a meal) HCPs believed caused the PwD to miss or skip insulin doses included “they forgot,” (bolus: 75.0%, basal: 67.5%) “they were too busy/distracted,” (bolus: 58.8%, basal: 48.3%), and “they were out of their normal routine” (bolus: 57.8%, basal: 48.6%). HCPs reported similar reasons that they believed caused PwD to mistime insulin doses. Digital technology and improved HCP-PwD communication were potential solutions identified by HCPs to optimize insulin dosing in PwD. Conclusions: The results of this study reveal HCPs believe the extent of suboptimal insulin dosing is less widespread than studies in PwD of self-reported insulin dosing. This discrepancy could lead to difficulties in HCPs giving PwD the best advice on optimal insulin management. Approaches such as improving the objectivity of dose measurements for both PwD and HCPs may improve associated communications and help reduce suboptimal insulin dosing, thus enhancing treatment outcomes.