Perceptions of Suboptimal Insulin Dosing from People with Diabetes and Healthcare Professionals in Germany

Despite advancements in diabetes therapeutics and innovations, suboptimal dosing continues to be a barrier to glycaemic control for people with diabetes (PwD). This study aimed to understand the extent of suboptimal insulin dosing and the factors underlying this behaviour from the perspective of PwD and healthcare professionals (HCPs) in Germany.

This analysis included 400 German PwD employing analogue insulin pens (type 1 diabetes, n = 100; type 2 diabetes, n = 300) and 160 HCPs (general practitioners, n = 80; specialists, n = 80), and was part of a cross-sectional, multinational, noninterventional web-based survey (1150 PwD and 640 HCPs). The proportion of PwD reporting missed/mistimed/miscalculated insulin doses and the mean ± SD number of insulin doses missed/mistimed/miscalculated within the last 30 days were analysed.

Among the 400 PwD (69.5% male, 30.5% female), the mean age was 47.1 ± 13.0 years. Within the last 30 days, 47.3% of PwD missed basal insulin doses (3.5 ± 2.9 mean number of insulin doses missed) and 58.0% missed bolus insulin doses (5.0 ± 10.1). Additionally, 47.3% and 51.0% mistimed basal insulin doses (3.9 ± 4.3 mean number of insulin doses mistimed) and bolus insulin doses (5.0 ± 7.1), respectively, and 47.5% and 63.3% PwD miscalculated basal insulin doses (4.5 ± 5.0 mean number of insulin doses miscalculated) and bolus insulin doses (5.5 ± 7.5), respectively. Of the 160 HCPs (73.1% male, 26.9% female), 98.1% were qualified for > 5 years. Overall, ≥ 67% HCPs indicated that up to 30% of PwD missed/forgot/skipped, mistimed, or miscalculated an insulin dose in the last 30 days. Reasons reported by PwD and HCPs included forgetting, being out of their normal routine, being too busy or distracted, or being unsure of how much insulin to take. PwD and HCPs suggested that having a device that automatically records glucose measurements, insulin doses, and timing and having dosing calculation guidance and real-time feedback on how insulin dosing impacts glucose levels would optimise insulin dosing.

PwD are mismanaging insulin doses largely for preventable reasons. Integrated and automated insulin dosing support may optimise insulin management and improve communication between PwD and HCPs.