Late and Missed Meal Boluses with Multiple Daily Insulin Injections

Norlander, Lisa; Anderson, Stacey M.; Levy, Carol J.; Ekhlaspour, Laya; Lam, David W.; Hsu, Liana; Loebner, Sarah E.; Ogyaadu, Selassie; O’Malley, Grenye; Levister, Camilla; Breton, Marc D.; Buckingham, Bruce

doi:10.2337/db18-992-p

Cited by 17 publications

(15 citation statements)

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“…7,39 A recent study observed that the rate of late or missed bolus injections was 27% in people using MDI therapy, and that missed bolus injections correlated with higher HbA 1c levels. 40 In a study of youths receiving insulin pump therapy, two missed bolus injections each week was associated with an increase in HbA 1c of 0.5% (5 mmol/mol). 39 Our findings indicate that a connected pen may help people to reduce the number of missed bolus injections and to properly adjust doses, thus leading to better glycemic control.…”

Section: Discussionmentioning

confidence: 99%

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

Adolfsson

Hartvig

Kaas

et al. 2020

Diabetes Technology & Therapeutics

111

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Background: This observational study investigated whether the connected NovoPen Ò 6 could influence insulin regimen management and glycemic control in people with type 1 diabetes (T1D) using a basal-bolus insulin regimen and continuous glucose monitoring in a real-world setting. Methods: Participants from 12 Swedish diabetes clinics downloaded pen data at each visit (final cohort: n = 94). Outcomes included time in range (TIR; sensor glucose 3.9-10.0 mmol/L), time in hyperglycemia (>10 mmol/L), and hypoglycemia (L1: 3.0-<3.9 mmol/L; L2: <3.0 mmol/L). Missed bolus dose (MBD) injections were meals without bolus injection within -15 and +60 min from the start of a meal. Outcomes were compared between the baseline and follow-up periods ( ‡5 health care professional visits). Data were analyzed from the first 14 days following each visit. For the TIR and total insulin dose analyses (n = 94), a linear mixed model was used, and for the MBD analysis (n = 81), a mixed Poisson model was used. Results: TIR significantly increased (+1.9 [0.8; 3.0] 95% CI h/day; P < 0.001) from baseline to follow-up period, with a corresponding reduction in time in hyperglycemia (-1.8 [-3.0; -0.6] 95% CI h/day; P = 0.003) and L2 hypoglycemia (-0.3 [-0.6; -0.1] 95% CI h/day; P = 0.005), and no change in time in L1 hypoglycemia. MBD injections decreased by 43% over the study (P = 0.002). Change in MBD injections corresponded to a decrease from 25% to 14% based on the assumption that participants had three main meals per day. Conclusions: Our study highlights the potential benefit on glycemic control and dosing behavior when reliable insulin dose data from a connected pen contribute to insulin management in people with T1D.

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Section: Discussionmentioning

confidence: 99%

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

Adolfsson

Hartvig

Kaas

et al. 2020

Diabetes Technology & Therapeutics

111

View full text Add to dashboard Cite

show abstract

“…The subjects used the Type Zero InControl Phone connected to a Dexcom G5 sensor and Novo insulin pen with memory. 28 Seven days of data were analyzed initially and 1 month later. More than one-quarter (27%; range = 8-55%) of subjects either took a late meal-time injection (13%, range = 2-30%) or missed a meal-time injection (14%, range = 2-38%).…”

Section: Missed or Delayed Insulin Dosesmentioning

confidence: 99%

The Reference Guide to Integrate Smart Insulin Pens Into Data-Driven Diabetes Care and Education Services

2020

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Purpose More than 7 million Americans who have diabetes use insulin therapy. The majority continue to use syringes and vials or traditional insulin pens to deliver their insulin doses. Using these tools to deliver insulin presents numerous challenges for both the person with diabetes and their clinicians. This article provides an in-depth introduction to a new category of insulin delivery devices and integrated management systems, referred to as smart insulin pens. The article includes information about how these integrated insulin delivery systems can reduce many of the challenges of rapid-acting insulin dosing via injection by enabling easier and more accurate dose recording, dose calculations, and sharing of diabetes management data with clinicians. This article also discusses new roles for diabetes care and education specialists in diabetes data-driven care and practice and addresses how smart insulin pens represent one of many newer digital diabetes management tools that can assist people with diabetes and their clinicians to optimally achieve and deliver quality, data-driven diabetes care. Conclusions Newer and simplified insulin delivery devices with their integrated management systems, such as smart insulin pens, have the potential to minimize the challenges and complexities associated with insulin injection therapy while also providing people with diabetes and their clinicians more complete and integrated data in easily transmitted reports that support more efficient data analysis.

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“…16 It is now estimated that mealtime insulin dosing is late or missed with 25%-27% of meals. 17,18 Modeling studies suggest that insulin omission can lead to worse glycemic control. For example, omitting 2.1 meal-related injections per week can lead to an increase in HbA 1c of at least 0.3%-0.4%, omitting 2.1 bolus injections per week would lead to an increase in HbA 1c of 0.2%-0.3%, and omitting 39% of all injections would lead to an increase in HbA 1c of 1.8%.…”

Section: Consequences Of Poor Pharmacoadherence To Insulin Therapymentioning

confidence: 99%

Pharmacoadherence: An Opportunity for Digital Health to Inform the Third Dimension of Pharmacotherapy for Diabetes

Klonoff

Zhang

Shang

et al. 2020

J Diabetes Sci Technol

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The basis of pharmacotherapy requires knowledge of two properties of a drug: pharmacokinetics (PK) and pharmacodynamics (PD). In the era of precision medicine, there is growing interest in determining between-individual variations in PK and PD. While these two dimensions of pharmacotherapy are key foci of investigation, a third property is also emerging as a critical factor in understanding how a drug affects an individual. This third property of a drug is known as phamacoadherence (PA). There can be wide variation in PA among people with diabetes, whether they are using oral or injectable medications. The use of new digital health interventions and telehealth communication tools, such as smart insulin pens, is now creating opportunities for health care professionals to have a more complete understanding of the PA of drugs, which allows for more personalized prescribing practices.

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Late and Missed Meal Boluses with Multiple Daily Insulin Injections

Cited by 17 publications

References 0 publications

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

The Reference Guide to Integrate Smart Insulin Pens Into Data-Driven Diabetes Care and Education Services

Pharmacoadherence: An Opportunity for Digital Health to Inform the Third Dimension of Pharmacotherapy for Diabetes

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