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01-11-2018 | Insulin delivery patches | Article

Patient Perceptions and Preferences for a Mealtime Insulin Delivery Patch

Journal: Diabetes Therapy

Authors: Mark Peyrot, Darlene Dreon, Vivien Zraick, Brett Cross, Meng H. Tan

Publisher: Springer Healthcare

Abstract

Introduction

A basal-bolus insulin regimen is needed to achieve glycated hemoglobin A1c (HbA1c) below 7.0% in people with type 1 (T1D) or type 2 (T2D) diabetes who have significant loss of beta-cell function. Nonadherence to therapy is common and negatively affects the ability to reach treatment goals. We examined patient assessment of a new, wearable mealtime insulin-delivery system (patch) relative to their current mealtime insulin-delivery system (syringe, pen, or pump). The patch is designed to deliver only boluses of fast-acting insulin (no basal insulin), mechanically controlled by the patient.

Methods

Adults (n = 101) with T1D or T2D assessed their current mealtime insulin-delivery system and then assessed simulated (no active medication) patch use over a 3-day period. Participants evaluated mealtime insulin-delivery systems using eight measures from five domains (convenience, interference with daily activities, diabetes-related worry, psychological well-being, and overall satisfaction/preference) on the self-administered Insulin Delivery System Rating Questionnaire. User ratings of their current insulin-delivery systems (syringe, pen, pump) were compared with those for the patch by repeated measure analysis of variance and one-sample t tests.

Results

Participants had significant (p < 0.05) preference for patch over syringe in all eight comparisons, and over pen in five out of eight comparisons, with no significant preference for pen. Although there was a preference for patch over pump in six out of eight comparisons, only one showed a significant preference for patch, and one for pump. Significantly more participants reported that they would like to switch to the patch than continue using a syringe (78% vs 22%) or pen (76% vs 24%) but this difference was not significant for the group using a pump (52% vs 48%).

Conclusions

Participants preferred using the patch over pens and syringes. Its ease of use and discreet method of insulin delivery may contribute to improved patient adherence to mealtime insulin regimens among people currently using injection devices.

Funding

Calibra Medical
Literature
1.
American Diabetes Association. Standards of medical care in diabetes. 5. Glycemic targets. Diabetes Care. 2016;39(Suppl 1):S39–46.
2.
Inzucchi S, Bergenstal R, Buse J, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015;58:429–42.CrossRefPubMed
3.
Imran SA, Rabasa-Lhoret R, Ross S. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada: targets for glycemic control. Can J Diabetes. 2013;37(Suppl 1):S31–4.CrossRefPubMed
4.
The Diabetes Control and Complications Trial (DCCT) Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.CrossRef
5.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.CrossRef
6.
National Diabetes Statistics Report. 2014. http://​www.​cdc.​gov/​diabetes/​pubs/​statsreport14/​national-diabetes-report-web.​pdf. Accessed Sept 15, 2016.
7.
Roussel R, Charbonnel B, Behar M, Gourmelen J, Emery C, Detournay B. High rates of early discontinuation of insulin therapy in type 2 diabetes: a nationwide study. Diabetes. 2015;64(Suppl 1):A252.
8.
Karter AJ, Subramanian U, Saha C, et al. Barriers to insulin initiation: the translating research into action for diabetes insulin starts project. Diabetes Care. 2010;33:733–5.CrossRefPubMedPubMedCentral
9.
Peyrot M, Rubin RR, Kruger DF, Travis LB. Correlates of insulin injection omission. Diabetes Care. 2010;33:240–5.CrossRefPubMedPubMedCentral
10.
Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabet Med. 2012;29:682–9.CrossRefPubMedPubMedCentral
11.
Bohannon N, Bergenstal R, Cuddihy R, et al. Comparison of a novel insulin bolus-patch with pen/syringe injection to deliver mealtime insulin for efficacy, preference, and quality of life in adults with diabetes: a randomized, crossover, multicenter study. Diabetes Technol Ther. 2011;13:1031–7.CrossRefPubMedPubMedCentral
12.
Rubin RR. Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am J Med. 2005;118(Suppl 5A):S27–34.CrossRef
13.
Kruger DF, LaRue S, Estepa P. Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment. Diabetes Metab Syndr Obes. 2015;8:49–56.CrossRefPubMedPubMedCentral
14.
Giugliano D, Maiorino MI, Bellastella G, Chiodini P, Ceriello A, Esposito K. Efficacy of insulin analogs in achieving the hemoglobin A1c target of < 7% in type 2 diabetes: meta-analysis of randomized controlled trials. Diabetes Care. 2011;34:510–7.CrossRefPubMedPubMedCentral
15.
Vinik AI, Kalk WJ, Botha JL, Jackson WP, Blake KC. The inexhaustible beta cell. Diabetes. 1976;25:11–5.CrossRefPubMed
16.
Service FJ, Hall LD, Westland RE, et al. Effects of size, time of day and sequence of meal ingestion on carbohydrate tolerance in normal subjects. Diabetologia. 1983;25:316–21.CrossRefPubMed
17.
Cerasi E, Luft R. The plasma insulin response to glucose infusion in healthy subjects and in diabetes mellitus. Acta Endocrinol (Copenh). 1967;55:278–304.
18.
Del Prato S. Loss of early insulin secretion leads to postprandial hyperglycaemia. Diabetologia. 2003;46(Suppl 1):M2–8.CrossRefPubMed
19.
Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes Care. 2003;26:881–5.CrossRefPubMed
20.
Varshney HM, Kumar R, Mohan S. Novel approaches for insulin delivery: current status. Int J Ther Appl. 2012;7:25–31.
21.
Anhalt H, Bohannon NJV. Insulin patch pumps: their development and future in closed-loop systems. Diabetes Technol Ther. 2010;12(Suppl 1):S51–8.PubMed
22.
Peyrot M, Rubin RR. Validity and reliability of an instrument for assessing health-related quality of life and treatment preferences: the Insulin Delivery System Rating Questionnaire. Diabetes Care. 2005;28:53–8.CrossRefPubMed
23.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Earlbaum Associates; 1988.
24.
Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41:582–92.PubMed
25.
Ritholz MD, Smaldone A, Lee J, Castillo A, Wolpert H, Weinger K. Perceptions of psychosocial factors and the insulin pump. Diabetes Care. 2007;30:549–54.CrossRefPubMed
26.
Summers KH, Szeinbach SL, Lenox SM. Preference for insulin delivery systems among current insulin users and nonusers. Clin Ther. 2004;26:1498–505.CrossRefPubMed
27.
Kerr D, Hoogma RP, Buhr A, Petersen B, Storms FE, Study investigators. Multicenter user evaluation of ACCU-CHEK® Combo, an integrated system for continuous subcutaneous insulin infusion. J Diabetes Sci Technol. 2010;4:1400–7.CrossRefPubMedPubMedCentral
28.
Klausmann G, Hramiak I, Qvist M, Mikkelsen KH, Guo X. Evaluation of preference for a novel durable insulin pen with memory function among patients with diabetes and health care professionals. Patient Prefer Adherence. 2013;7:285–92.PubMedPubMedCentral
29.
Mader JK, Lilly LC, Aberer F, et al. A feasibility study of a 3-day basal-bolus insulin delivery device in individuals with type 2 diabetes. Diabetes Care. 2014;37:1476–9.CrossRefPubMed
30.
Barnard KD, Bromba M, de Lange M, et al. High reported treatment satisfaction in people with type 1 diabetes switching to latest generation insulin pump regardless of previous therapy. J Diabetes Sci Technol. 2015;9:231–6.CrossRefPubMedPubMedCentral
31.
Berard L, Cameron B, Woo V. Pen needle preference in a population of Canadians with diabetes: results from a recent patient survey. Can J Diabetes. 2015;39:206–9.CrossRefPubMed
32.
Hanestad BR, Albreksten G. Quality of life, perceived difficulties in adherence to diabetes regimen, and blood glucose control. Diabet Med. 1991;8:759–64.CrossRefPubMed
33.
Polinski JM, Smith BF, Curtis BH, et al. Barriers to insulin progression among patients with type 2 diabetes: a systematic review. Diabetes Educ. 2013;39:53–65.CrossRefPubMed
34.
Sorli C, Heile MK. Identifying and meeting the challenges of insulin therapy in type 2 diabetes. J Multidiscip Healthc. 2014;7:267–82.CrossRefPubMedPubMedCentral

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