Perceptions of diabetes control among physicians and people with type 2 diabetes uncontrolled on basal insulin in Sweden, Switzerland, and the United Kingdom

Abstract

Objective A large proportion of people with type 2 diabetes (T2D) remain uncontrolled on basal insulin. Yet, there is limited understanding of how people with uncontrolled type 2 diabetes (PWUD) perceive control and insulin intensification and whether their perceptions differ from those of physicians. The purpose of the study was to investigate perceptions of control and views on insulin intensification among physicians and PWUD.

Research design and methods Web surveys of 1012 PWUD on basal insulin and 300 physicians were conducted in Sweden, Switzerland, and the United Kingdom.

Results Analyses revealed significant differences between physicians and PWUD. Physicians were significantly more likely than PWUD to indicate that HbA1c (85.0% vs. 78.9%, p < 0.05), complications from diabetes (89.3% vs. 75.3%, p < 0.001), and frequency/severity of hypoglycemia (93.3% vs. 68.6%, p < 0.001) were very/extremely important for deciding whether or not diabetes is well controlled. In contrast PWUD were significantly more likely to place importance on a variety of factors, including energy levels (74.5% vs. 33.0%, p < 0.001), insulin units/day (77.6% vs. 29.0%, p < 0.001) and how predictable life is (72.1% vs. 29.3%, p < 0.001). PWUD also perceived significantly greater obstacles to control and viewed uncontrolled T2D as more interfering in their lives compared to physicians. Physicians were most reluctant to intensify insulin when there is a lack of patient agreement. Worries about weight gain and feelings of ‘getting sicker’ were the most frequently reported reasons why PWUD on basal insulin were reluctant to intensify insulin.

Conclusions Results revealed a significant disconnect between physicians and PWUD in their perceptions of diabetes control. While physicians generally expressed a more focused and clinical view of diabetes control, patients had a broader view. Results also provide insights into PWUD and physicians’ reluctance to intensify insulin. The findings suggest that physician and patient education on differing perceptions could benefit communication and improve diabetes management.

Keywords:

• Diabetes control
• Diabetes management
• Insulin intensification
• Perceptions of control

Declaration of funding

This research was supported by Novo Nordisk.

Author contributions: Data analysis was conducted by M.B. and K.M.P. All authors contributed to the preparation of the manuscript. The study sponsor had no role in the preparation of the manuscript.

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. A.H.B. has disclosed that he has received honoraria for lectures and advisory work from Novo Nordisk, Eli Lilly, Sanofi-Aventis, MSD, Novartis, Boehringer Ingelheim, AstraZeneca, Janssen, and Roche. K.B. has disclosed that she has received honoraria for lectures and advisory work from Novo Nordisk, Eli Lilly, Sanofi-Aventis, MSD, Boehringer Ingelheim, and AstraZeneca. T.V. has disclosed that she has received lecture fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly and Company, Merck Sharp & Dohme, Novo Nordisk, Novartis, Sanofi, and Zealand Pharma, and is a member of the Advisory Boards of AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly and Company, Merck Sharp & Dohme, Novo Nordisk, and Sanofi. B.W. has disclosed that he has received honoraria for lectures and advisory work from AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, MSD, and Novo Nordisk.

CMRO peer reviewer 1 has disclosed that she has given talks and attended conferences sponsored by AstraZeneca, MSD, Novo Nordisk, Angelini, Novartis, Pfizer, WinMedica and Libytec and also participated in trials sponsored by Amgen and Novartis. CMRO peer reviewer 2 has no relevant financial or other relationship to disclose.

Acknowledgments

Previous presentation: Material in this paper has been presented previously in ‘Perceptions of diabetes control among physicians and patients with uncontrolled type 2 diabetes using basal insulin,’ poster presented at the 51st Annual Meeting of the European Association for the Study of Diabetes (PS 082, Poster 890), 14–18 September 2015, Stockholm, Sweden.