Abstract
Objective
The objective of this study is to evaluate the impact of sequential telephonic interviews on treatment persistence and daily adherence to insulin injections among insulin-naïve type 2 diabetes patients initiated on different insulin regimens in a 3-month period.
Methods
A total of 1,456 insulin-naïve patients with type 2 diabetes (mean [standard deviation, SD] age: 56.0 [12.0] years, 49.1% were females) initiated on insulin therapy and consecutively randomized to sequential (n=733) and single (n=723) telephonic interview groups were included. Data on insulin treatment and self-reported blood glucose values were obtained via telephone interview. Logistic regression analysis was performed for factors predicting increased likelihood of persistence and skipping an injection.
Results
Overall, 76.8% patients (83.2% in sequential vs 70.3% in single interview group, (P<0.001) remained on insulin treatment at the third month. Significantly higher rate for skipping doses was noted in basal bolus than in other regimens (27.0% vs 15.0% for premixed and 15.8% basal insulin, respectively, P<0.0001). Logistic regression analysis revealed sequential telephonic interview (odds ratio [OR], 1.531; 95% confidence interval [CI], 1.093–2.143; P=0.013), higher hemoglobin A1c levels (OR, 1.090; 95% CI, 0.999–1.189; P=0.049), and less negative appraisal of insulin therapy as significant predictors of higher persistence. Basal bolus regimen (OR, 1.583; 95% CI, 1.011–2.479; P=0.045) and higher hemoglobin A1c levels (OR, 1.114; 95% CI, 1.028–1.207; P=0.008) were the significant predictors of increased likelihood of skipping an injection.
Conclusion
Our findings revealed positive influence of sequential telephonic interview, although including no intervention in treatment, on achieving better treatment persistence in type 2 diabetes patients initiating insulin.
Acknowledgments
The members of the Dropout Study Group are listed below: Dilek GogasYavuz, MD, Faculty of Medicine, Marmara University, Istanbul, Turkey; Habip Bilen, MD, Faculty of Medicine, Ataturk University, Erzurum, Turkey; Seda Sancak, MD, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey; Tayfun Garip, MD, and Dilek Arpaci, MD, Sakarya State Hospital, Sakarya, Turkey; Zeliha Hekimsoy, MD, Faculty of Medicine, Celal Bayar University, Manisa, Turkey; Ibrahim Sahin, MD, Faculty of Medicine, Inonu University, Malatya, Turkey; Murat Yilmaz, MD, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey; Hasan Aydin, MD, Faculty of Medicine, Yeditepe University, Istanbul, Turkey; Aysegul Atmaca, MD, Faculty of Medicine, Ondokuzmayıs University, Samsun, Turkey; Murat Sert, MD, Faculty of Medicine, Cukurova University, Adana, Turkey; Pinar Karakaya, Bakirkoy Training and Research Hospital, Istanbul, Turkey; Aytekin Oguz, MD, Faculty of Medicine, Medeniyet University, Istanbul, Turkey; Nilgun Guvener, Faculty of Medicine, Baskent University, Istanbul, Turkey; Serpil Esmen, RN, Faculty of Medicine, Marmara University, Istanbul, Turkey; Sevin Dakak, RN, Faculty of Medicine, Ataturk University, Erzurum, Turkey; Behice Kahraman, RN, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey; Betül Beyaz, RN, Sakarya State Hospital, Sakarya, Turkey; Sinem Yaman, RN, Faculty of Medicine, Namık Kemal University, Tekirdag, Turkey; Deniz Sarı, RN, Faculty of Medicine, CelalBayar University, Manisa, Turkey; Sibel Günışık, RN, Faculty of Medicine, Inonu University, Malatya, Turkey; Betül Demir, RN, Faculty of Medicine, Yeditepe University, Istanbul, Turkey; Gülay Bayrak, RN, Faculty of Medicine, Ondokuzmayıs University, Samsun, Turkey; Ayfer Bahtiyar, RN, Faculty of Medicine, Cukurova University, Adana, Turkey; Neşe Işık, RN, Bakirkoy Training and Research Hospital, Istanbul, Turkey; Nurdan Yörük, RN, Faculty of Medicine, Medeniyet University, Istanbul, Turkey; and Emel Nur Ulusoy, RN, Faculty of Medicine, Baskent University, Istanbul, Turkey.
Disclosure
The authors report no conflicts of interest in this work.