Understanding bolus insulin dose timing: the characteristics and experiences of people with diabetes who take bolus insulin

Abstract

Objective: Despite the increased popularity of newer, fast-acting bolus insulin treatment options that allow for more flexibility in the timing of bolus insulin dosing in recent years, relatively little is known about people with diabetes who administer bolus insulin at differing times in relation to their meals. The purpose of this study was to investigate bolus insulin dose timing in relation to meals among people with type 1 (T1D) and type 2 (T2D) diabetes, as well as to better understand the characteristics and experiences of people who bolus dose at differing times.

Methods: A web-based survey of adults with T1D and T2D treated with bolus insulin therapy in Germany, the UK, and USA was conducted.

Results: A total of 906 respondents completed the survey (39% T1D; 61% T2D). A majority of respondents reported bolus dosing before meals in the previous week (57.0%), followed by after meals (18.9%), with meals (12.7%), and at varying times (11.5%). Compared to respondents who dosed with or after meals, those who dosed before meals were significantly less likely to experience hypoglycemia (before, 55.7%; with, 72.8%; after, 68.7%; p < .001) in the previous week. Respondents who bolus dosed before meals were significantly more likely to perceive bolus dose timing as flexible (45.5%) compared to those who dosed with (27.8%) or after (35.7%) meals (p < .001).

Conclusion: Results show that many people with T1D and T2D dose their bolus insulin with or after meals. Key limitations of all self-report surveys include potential bias in responses and generalizability of findings. However, the study was designed to help mitigate these limitations. The findings have implications for clinicians and suggest opportunities for improving diabetes education and care.

Keywords:

• Bolus insulin
• diabetes management
• diabetes mellitus, type 1
• diabetes mellitus, type 2
• rapid-acting insulin
• self-care

Transparency

Declaration of funding

This study was funded by Novo Nordisk A/S, Søborg, Denmark.

Author contributions: Data analysis was conducted by M.B. and K.M.P. All authors contributed to the interpretation of study results and to the conception and preparation of the manuscript. All authors have approved this version of the manuscript. All authors agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

M.B. and K.M.P. have disclosed that they are paid consultants to the pharmaceutical industry, including Novo Nordisk. W.V.T. has disclosed that he is a paid consultant for Novo Nordisk, Sanofi, and Medtronic. A.N. and A.S. have disclosed that they are employees of Novo Nordisk A/S. A.L.P. has disclosed that she has received advisory board/consulting fees from: Abbott Diabetes Care, Becton Dickinson, Bigfoot Biomedical, Boehringer Ingelheim, Eli Lilly and Company, Astra-Zeneca, Intarcia, Janssen, Lexicon, Medtronic-Minimed, Merck, Novo Nordisk, Omada Health, OptumRx, and United Healthcare; she speaks at CME programs supported by many of the same companies; she has received research support from: Janssen, Dexcom and the Medtronic Foundation and editorial fees from Medscape outside the submitted work. M.V.N. has disclosed that she has no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to thank Jane Beck of The Brod Group for providing editorial support for the manuscript.