Perceived medication benefits and their association with interest in using inhaled insulin in type 2 diabetes: a model of patients’ cognitive framework

Figures & data

Table 1 Sample profile by medication group

Measures	Oral only (n = 734)	Basal insulin (n = 228)	MDI (n = 132)	Total (n = 1094)
Demographics
Age (years)	57.0 ± 10.7	58.5 ± 9.3	57.7 ± 11.4	57.4 ± 10.5
Female	47.1 (346)	57.0 (130)	59.1 (78)	50.6 (554)
Race/ethnicity
White	75.6 (555)	79.4 (181)	85.6 (113)	77.6 (849)
Black	11.7 (86)	10.5 (24)	9.8 (13)	11.2 (123)
Hispanic	9.3 (68)	7.0 (16)	2.3 (3)	8.0 (87)
Other race	3.4 (25)	3.1 (7)	2.3 (3)	3.2 (35)
Education*	5.2 ± 1.7	5.0 ± 1.6	4.8 ± 1.7	5.1 ± 1.6
Income (thousands of $)**	53.4 ± 36.0	46.5 ± 33.1	46.0 ± 38.2	51.1 ± 35.8
Health care
Health care provider***
PCP	87.3 (641)	78.9 (180)	60.9 (81)	82.4 (902)
Endocrinologist	9.9 (73)	19.7 (45)	34.6 (46)	15.0 (164)
Other HCP	2.7 (20)	1.3 (3)	4.5 (6)	2.6 (29)
Health insurance*
No insurance	7.1 (52)	4.8 (11)	3.8 (5)	6.2 (68)
Private insurance	71.4 (525)	64.8 (147)	66.2 (88)	69.4 (760)
Medicare insurance	8.8 (65)	14.1 (32)	12.0 (16)	10.3 (113)
Military insurance	7.1 (52)	7.9 (18)	6.8 (9)	7.2 (79)
Medicaid insurance	5.6 (41)	8.4 (19)	11.3 (15)	6.8 (75)
Disease
Pen use***	0 (0)	23.2 (53)	40.2 (53)	9.7 (106)
Duration of DM***	8.1 ± 7.1	13.4 ± 8.6	15.6 ± 10.0	10.1 ± 8.3
Hypoglycemia***
NA	10.9 (80)	4.8 (11)	1.5 (2)	8.5 (93)
None	36.6 (269)	18.9 (43)	15.2 (20)	30.3 (332)
Occasionally	46.7 (343)	67.0 (152)	69.7 (92)	53.7 (587)
Frequently	5.9 (43)	9.3 (21)	13.6 (18)	7.5 (82)
Hyperglycemia***
NA	10.9 (80)	4.8 (11)	1.5 (2)	8.5 (93)
None	19.2 (141)	12.7 (29)	6.8 (9)	16.4 (179)
Occasionally	50.7 (372)	48.7 (111)	43.2 (57)	49.4 (540)
Frequently	19.2 (141)	33.8 (77)	48.5 (64)	25.8 (282)
BMI***	35.2 ± 8.0	37.6 ± 9.6	37.1 ± 9.5	35.9 ± 8.6
Nr of comorbidities***	1.9 ± 1.2	2.2 ± 1.3	2.6 ± 1.6	2.1 ± 1.3
Depression (taking medication)***	15.6 (115)	24.2 (55)	25.6 (34)	18.6 (204)
Beliefs
Poor DM control***	30.8 ± 18.1	39.5 ± 17.7	40.2 ± 15.8	33.7 ± 18.2
Hypoglycemia fear***	38.2 ± 29.5	48.3 ± 28.8	49.8 ± 31.9	41.7 ± 30.1
Weight concern***	50.9 ± 22.5	60.1 ± 24.5	65.5 ± 24.4	54.6 ± 24.0
Negative injections***	50.8 ± 22.1	28.6 ± 20.3	23.7 ± 19.6	42.9 ± 24.3
Treatment restrictions***	32.8 ± 26.4	42.9 ± 27.2	41.9 ± 29.5	36.0 ± 27.3
Study medication benefit relevance
Avoid high BG***	68.1 ± 29.2	75.8 ± 24.3	77.3 ± 26.1	70.8 ± 28.1
Avoid low BG***	61.2 ± 31.5	69.6 ± 27.7	68.5 ± 30.9	63.8 ± 30.8
Avoid weight gain**	70.1 ± 30.9	74.8 ± 28.0	79.3 ± 27.6	72.2 ± 30.1
Avoid discomfort and inconvenience	65.6 ± 32.3	66.2 ± 29.3	65.0 ± 33.0	65.6 ± 31.3
Study medication benefit rating
Avoid high BG***	15.8 ± 21.1^a	22.7 ± 19.6^a	22.2 ± 20.3^a	18.0 ± 20.9^a
Avoid low BG***	13.6 ± 20.9^a	21.0 ± 20.3^a	19.8 ± 21.4^a	15.9 ± 21.0^a
Avoid weight gain***	16.8 ± 22.5^a	25.7 ± 20.5^a	23.9 ± 21.4^a	19.5 ± 22.2^a
Avoid discomfort and inconvenience***	17.8 ± 23.7^a	25.0 ± 22.2^a	24.2 ± 22.4^a	20.1 ± 23.4^a
Study medication assessment
Comparison to current medication***	15.3 ± 25.2^a	25.7 ± 21.7^a	26.8 ± 20.9^a	18.9 ± 24.6^a
Interest in using	67.2 ± 27.6	69.9 ± 28.7	73.2 ± 27.9	68.5 ± 27.9
Impact on insulin initiation	28.7 ± 23.1	NA	NA	28.7 ± 23.1

Notes: Education: 1 = less than high school, 2 = completed some high school, 3 = high school graduate or equivalent, 4 = trade school, 5 = completed some college, 6 = college graduate, 7 = completed some graduate work, 8 = completed graduate degree. Cell entries are mean ± standard deviation or % (n).

a Mean is significantly P < 0.001) different from rating of no difference from current medication (=0).

* P < 0.05 for medication group differences;

** P < 0.01 for medication group differences;

*** P < 0.001 for medication group differences.

Abbreviations: BG, blood glucose; BMI, body mass index; DM, diabetes mellitus; HCP, health care provider; MDI, multiple daily insulin injection; NA, not ascertained; PCP, primary care provider.

Table 2 Correlates of benefit relevance ratings, interest in study medication, and comparison of study medication to current medication^a

Correlate	Relevance of avoiding high BG	Relevance of avoiding low BG	Relevance of avoiding weight gain	Relevance of avoiding discomfort and inconvenience	Compare study medication to current medication	Interest in study medication
Demographics
Age (years)	−0.022	0.023	−0.039	0.004	0.051	0.028
Female	0.078*	0.094**	0.099***	0.097**	0.013	−0.029
Black^b	0.048	0.085**	0.044	0.079*	0.043	−0.023
Hispanic^b	0.046	0.070*	0.042	0.054	0.090***	0.047
Other race^b	0.000	0.006	−0.012	0.003	0.045	0.020
Education	0.045	0.016	0.067*	0.050	−0.060*	0.011
Income	0.028	0.028	0.046	−0.012	0.060*	0.072*
Health care
Endocrinologist^e	−0.010	−0.024	−0.029	−0.037	−0.016	−0.051
Other HCP^e	−0.070*	−0.020	−0.057*	−0.039	−0.022	−0.014
No insurance^f	−0.004	−0.008	0.024	−0.001	0.046	0.040
Medicare insurance^f	−0.006	−0.021	−0.032	−0.045	0.010	−0.059
Military insurance^f	−0.023	−0.041	0.010	0.022	0.008	−0.046
Medicaid insurance^f	0.041	0.022	0.008	0.029	0.039	0.039
Disease
Basal insulin^c	0.026	0.034	−0.006	0.029	0.023	−0.034
MDI^c	0.010	0.000	0.011	0.009	0.028	0.016
Pen use	0.061	0.021	0.035	0.055	0.039	0.019
Duration of DM	−0.032	−0.028	0.027	−0.041	0.008	0.014
BMI (log)	−0.052	−0.058	0.073*	−0.004	0.018	−0.002
Nr of comorbidities	0.028	0.004	0.054	0.093**	0.032	0.048
Depression	0.031	−0.001	0.042	−0.043	−0.013	0.028
Hypoglycemia (occasionally)^d	0.001	0.154***	0.026	0.004	0.014	−0.056
Hypoglycemia (frequently)^d	−0.018	0.150***	0.034	−0.010	−0.030	−0.040
Hyperglycemia (occasionally)^d	0.149***	−0.055	0.000	−0.016	0.075*	0.045
Hyperglycemia (frequently)^d	0.205***	−0.012	0.056	0.057	0.117**	0.038
Beliefs
Poor DM control	0.120***	0.053	0.009	0.038	0.075*	0.050
Hypoglycemia fear	0.001	0.217***	−0.029	0.035	−0.009	−0.013
Weight concern	0.128***	0.073*	0.344***	0.064	0.024	0.068*
Negative injections	−0.012	−0.036	0.001	0.174***	−0.011	0.026
Treatment restrictions	0.095**	0.055	−0.011	0.087*	0.143***	0.040
Benefits
Avoid high BG					0.196***	0.188***
Avoid low BG					0.009	0.046
Avoid weight gain					0.127**	0.074
Avoid discomfort and inconvenience					0.174***	0.224***
R-squared	0.165	0.166	0.241	0.125	0.381	0.301

Notes:

a Cell entries are standardized regression coefficients;

b Reference category = White;

c Reference category = Oral medication only;

d Reference category = No hypoglycemia or hypoglycemia;

e Reference category = PCP;

f Reference category = Private insurance.

* P < 0.05;

** P < 0.01;

*** P < 0.001.

Abbreviations: BG, blood glucose; BMI, body mass index; DM, diabetes mellitus; HCP, health care provider; MDI, multiple daily insulin injection; NA, not ascertained; PCP, primary care provider.