Adherence to insulin treatment in insulin-naïve type 2 diabetic patients initiated on different insulin regimens

Figures & data

Table 1 Baseline patient characteristics

Demographics
Age (year)	55.5±13.0
Sex, n (%)
Female	227 (52.4)
Male	206 (47.6)
Diabetes duration (years)	8.7±6.6
Glycemic parameters
Fasting blood glucose (mg/dL)	150.0±62.0
Postprandial blood glucose (mg/dL)	195.0±77.0
HbA1c (%)	11.2±1.5
Prescribed insulin regimen, n (%)
Basal bolus (NPH, detemir, glargin regular, lispro, glulisin or aspart)	220 (51.0)
Basal insulin (NPH, detemir, or glargine)	112 (26.0)
Premixed (30/70, 50/50 or 25/75)	95 (22.0)
Short acting (Regular human, lispro, glulisine or aspart)	6 (1.0)

Note: Values are expressed as mean ± SD unless otherwise specified.

Abbreviations: HbA_1c, glycated hemoglobin; SD, standard deviation.

Table 2 Questionnaire data on insulin treatment related items

Blood glucose monitoring (n=250), n (%)
Self-monitoring via glucometer	230 (92.0)
Monitoring at hospital	20 (8.0)
Administration of insulin pen (n=329), n (%)
Self-injection	257 (78.1)
By others	72 (21.9)
Evaluation of injection procedure (n=320), n (%)
Painless	278 (87.0)
Causes itching at the injection site	42 (13.1)
Nonadherence, n (%)	192 (44.3)
Nonpersistence#	104 (24.0)
Daily insulin nonadherence	88 (20.3)
All-cause treatment discontinuation, n (%)
Including deaths	104 (24.0)
Excluding deaths	87 (20.1)
Reasons for treatment discontinuation,# n (%)
Patient-related	66 (75.9)
Negative beliefs (risk of dependency, weight gain) about insulin therapy	21 (24.1)
Preference of oral medication	18 (20.6)
Normalization of blood glucose levels	16 (18.3)
Fear of injection/bleeding	5 (5.7)
Influence of family members and friends	6 (6.8)
Physician-related	12 (13.7)
Adverse events	7 (8.0)
Major hypoglycemia	2 (2.3)
Allergic skin reaction	3 (3.5)
Leg edema	2 (2.3)
Challenges in drug procurement	2 (2.2)
Reasons for dose skipping (n=88), n (%)
Forgetting	36 (40.9)
Hypoglycemia	8 (9.0)
Normalization of blood glucose	5 (5.6)
Drug unavailability	8 (9.0)
Feeling good/consideration of injection unnecessary	20 (22.7)
Workload	7 (7.9)
Inability to eat	4 (4.5)

Note:

# Based on treatment withdrawal in 87 patients after exclusion of 17 deaths.

Table 3 Characteristics of patients persistent or nonpersistent with insulin treatment

	Insulin treatment		P-value
	Persistent patients (n=329)	Nonpersistent patients (n=104)
Age (year)	56.4±12.0	49.5±15.0	0.001†,*
Sex (F/M), n	179/150	48/56	0.5‡
Literacy, n (%)	197 (60.0)	60 (58.0)	0.4‡
Diabetes duration (year)	8.8±6.3	4.8±4.3	0.0008†,*
HbA1c (%)	10.1±1.8	10.4±2	0.4†
Treatment duration (months)	10.7±2.4	5.2±2.4	0.0001*

Notes: Values are expressed as mean ± SD unless otherwise specified.

† Student’s t-test.

‡ Chi-square test.

* Significant.

Abbreviations: HbA_1c, glycated hemoglobin; SD, standard deviation.

Table 4 Demographic and clinical variables in continuers according to insulin regimen

	Basal bolus (n=162)	Premixed (n=85)	Basal insulin (n=78)	P-value
Sex (F/M), n	87/75	45/40	47/31	0.09‡
Age (year)	55.1±11.9	56.0±10.5	59.1±3.2	0.059†
Diabetes duration (year)	8.4±6.3	8.6±6.8	8.2±6.0	0.5†
Daily insulin dose (IU/day)	54.5±24.1	39.3±18.0	19.6±11.4	<0.0001†
Fasting blood glucose (mg/dL)	153.5±66.6	148.2±44.8	131.4±49.0	0.03†
Postprandial blood glucose (mg/dL)	181.0±73.0	166.0±54.0	197.0±74.0	ns†
Number of follow-up visits performed	2.0±1.2	1.5±0.7	2.1±0.2	0.03†
Minor hypoglycemia, n (%)	101 (62.3)	46 (54.1)	39 (50.0)	<0.05‡
Major hypoglycemia, n (%)	4 (2.4)	4 (4.7)	4 (5.1)	0.5‡

Notes: Values are expressed as mean ± SD unless otherwise specified.

† ANOVA.

‡ Chi-square test.

Abbreviations: ANOVA, analysis of variance; SD, standard deviation.

Table 5 Characteristics of the type 2 diabetic patients persistent with insulin therapy, in terms of skipping doses

	Skipping doses		P-value
	Yes (n=88)	No (n=241)
Age (years)	54.0±10.5	57.2±12.0	0.03†,*
Sex (F/M), n	42/46	139/102	0.5‡
Diabetes duration (year)	7.6±5.5	9.6±6.7	0.07†
Daily insulin dose (IU/day)	46.9±24.0	40.2±24.0	0.03†,*
Insulin regimen, n (%)
Basal bolus	54 (61.3)	111 (46.0)	0.04‡,*
Premixed	20 (22.7)	58 (24.0)
Basal insulin	14 (15.9)	72 (27.3)
Fasting blood glucose (mg/dL)	153.7±63.0	146.5±57.0	0.30†
Postprandial blood glucose (mg/dL)	191.5±65.0	179.6±72.0	0.04†,*
Omitting dose for >1 day (2–5 days), n (%)	8 (9.4)	–	–

Notes: Values are expressed as mean ± SD unless otherwise specified.

† Student’s t-test.

‡ Chi-square test.

* Significant.

Abbreviation: SD, standard deviation.