Introduction: An international cross-sectional survey (GAPP2™), with a cohort in Australia, was conducted to increase the understanding of basal insulin-taking behaviours with an aim to investigate the frequency and impact of basal insulin dosing irregularities in type 2 diabetes (T2DM).
Method: Respondents were recruited through pre-existing general population research panels. In Australia, 112 patients with T2DM on basal insulin analogues (mean age 62±0.82 years; 54% male) and 146 prescribers involved in the care of such patients completed two online questionnaires (patient and prescriber) between September 2012 and January 2013.
Results: Basal insulin dosing irregularities were reported by patients: 21% missed, 20% mistimed (+/- 2 hours from prescribed time) and 14% reduced a basal dose in the preceding 30 days. On the most recent occasion patients reduced basal insulin, 89% did so intentionally and the most common reasons were low blood sugar levels and hypoglycaemia risk reduction. Only 57% of patients on basal insulin believed missing basal doses would negatively impact on long-term health, with 33% reported they believed there would be no impact on long-term health. However, 43% of patients worried about missing occasional basal doses. Prescribers suspected 38% of their basal insulin patients hide the number of missed basal doses during consultations, but just 11% of patients on basal insulin admitted to omitting missed doses to their clinicians. Only 68% of prescribers reported to routinely discuss basal dosing irregularities in consultations.
Conclusion: The survey found basal insulin dosing irregularity with some patients deliberately adjusting doses. Patient worry, their belief on the impact missed basal doses on health and the lack of agreement between patients and prescribers on downplayed doses suggest improved education and patient-prescriber dialogue could be beneficial.
The GAPP2™ survey was supported by a grant from Novo Nordisk.