Abstract
Background
Insulin analogs are regarded as more convenient to use than human insulin; however, they require a different administration scheme due to their unique pharmacokinetic and pharmacodynamic properties. This study aimed to assess difficulties with adherence to treatment with insulin analogs in patients with type 2 diabetes mellitus (T2DM), who had previously been treated with human insulin. The associations between difficulties with adherence and clinical, demographic, and psychological characteristics were also evaluated.
Patients and methods
The study was conducted on 3,467 consecutively enrolled patients with T2DM (54.4% women), mean age 63.9 years (SD =9.57), who had recently undergone a physician-directed change in treatment from human insulin to insulin analogs. The questionnaires addressed difficulties with switching the therapy, coping styles, well-being, and perception of self-influence on the disease.
Results
No adherence problems in switching therapy were reported in 56.6% of patients. Specific moderate difficulties were reported in 10.4%–22.1% of patients, major difficulties in 0.7%–6.9% of patients, and very significant difficulties in 0.03%–1.3% of patients. Overall, remembering to modify the insulin dose in the case of additional meals was the most frequently reported difficulty, and problems with identifying hypoglycemic symptoms were the least frequently reported. The increased risk of difficulties was moderately related to low perception of self-influence on diabetes and poor well-being. The intensity of problems was higher among those who were less-educated, lived in rural areas, had complications, and/or reported maladaptive coping styles.
Conclusion
Switching from human insulin to an insulin analog did not cause adherence problems in more than half of the patients. In the remaining patients, difficulties in adherence correlated with maladaptive coping styles, low perception of self-influence on disease course, and depressive symptoms.
Supplementary material
Table S1 Questionnaire on possible difficulties at the time of switch from human insulin to insulin analogs (completed by the physician and the patient)
Any change in treatment may present potential challenges for patients. A switch from human insulins to insulin analogs may also pose such risk. Therefore, I am asking you to assess whether – and if so to what extent – this change in treatment makes a problem in the context of the following issues. Please, rate, whether each of the problems mentioned in the following questions caused: no problem, insignificant problem, moderate problem, major problem, or very significant problem.
You may find answering these questions easier if you look at the questionnaire together with me.
Acknowledgments
The author would like to acknowledge Rafał Radzio, PhD from SWPS University of Social Sciences and Humanities, for help in statistical analysis, and Proper Medical Writing Sp. z o.o., in particular Karolina Beda-Maluga, PhD, and Maria Kołtowska-Häggström, MD, PhD, for their help in editing and structuring the paper, and Ashley Cooper, BSc (Hons 1)/BJ for linguistic corrections of the manuscript. The study and the paper preparation were fully sponsored by a grant from Novo Nordisk Poland; the grant was given to the Foundation for the Development of Psychiatry and Psychotherapy.
Disclosure
AK, as a principal investigator of the study received honorarium from the Foundation for Development Psychiatry and Psychotherapy.
Novo Nordisk Poland sponsored participation of AK in meetings of Psychosocial Aspects of Diabetes (PSAD) Study Group an official Study Group of the European Association for the Study of Diabetes (EASD).