Treatment flexibility will improve adherence in diabetes, study suggests
pharmafile | June 29, 2011 | News story | Research and Development, Sales and Marketing | diabetes, insulin
A third of patients with diabetes admit to regularly missing or not taking insulin treatment three days a month, according to a new poll.
The findings are part of a global survey sponsored by Novo Nordisk and presented at the American Diabetes Association’s annual meeting in San Diego.
The Global Attitudes of Patients and Physicians in Insulin Therapy (GAPP) survey found a high level of insulin omission/non-adherence in a sample of 1,530 adults with type 1 (12%) or type 2 (88%) diabetes who use insulin.
“One of the reasons people with diabetes struggle with adherence could be due to the strict treatment regimens they must follow,” said Mark Peyrot, professor of sociology at Loyola University, Maryland and author of the GAPP study presented at ADA. “A more flexible schedule would help patients fit their treatment into their lifestyle, thereby improving adherence and potentially improving their clinical outcomes too.”
Key conclusions from this large scale survey were:
·Insulin omission/non-adherence was more frequent among respondents who were younger, who had more frequent hypoglycaemia, who were less successful with other treatment tasks (for example glucose monitoring), who regarded insulin adherence as less important, who had more practical/logistical barriers to insulin adherence (for example due to travelling or altered daily routine), and who were concerned that insulin treatment required lifestyle changes
· Satisfaction with insulin therapy, especially flexibility of injection timing, was associated with higher adherence
· Hypoglycaemia increased the risk of insulin omission/non-adherence, possibly because insulin omission/non-adherence is used as a strategy for reducing fear of hypoglycaemia
· One-third (35%) of respondents reported one or more days (mean ~3) of insulin omission/non-adherence in the previous month
· Insulin omission/non-adherence was highest in Turkey, followed by the US, China and Japan, and lowest in France, Germany, UK and Spain
Novo Nordisk says the findings support the theory that insulin non-adherence is common and associated with several modifiable risk factors (including practical barriers such as when travelling/missing meals as well as lifestyle burden and regimen inflexibility e.g. having to take insulin at the prescribed time every day/with each meal).
The authors of the study suggest efforts to raise awareness and educate the public should focus on addressing these risk factors. By developing and implementing strategies to minimise patient barriers to insulin adherence or by prescribing insulin regimens that are more flexible and fit more easily into patients’ lifestyles, compliance to treatment could be improved, which may lead to improved clinical outcomes for patients.
UK-specific findings from the GAPP study:
· Of the 205 UK patients surveyed, approximately one-third (32%) said they struggle to maintain good blood glucose levels, this is lower than the global average (38%)
· A significant proportion of UK patients reported missing their insulin doses or failing to take their insulin as prescribed, with four in ten (41%) saying this, compared to the global average of 35 per cent
· Two in three (64%) UK patients are looking for an insulin regimen that fits better into the changing needs of their everyday lives and almost half (45%) admit that their insulin programme can be restrictive
· Over half (51%) of UK physicians admitted to being dissatisfied with the number of injections required per week by current insulin treatments
· UK physicians are significantly more likely than the overall global survey average to agree that a large proportion of diabetes patients are not reaching HbA1C targets, with nearly all (97%) saying this, compared with 88% overall
Andrew McConaghie
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