727-P: The Association between Missed Basal Insulin Injections and Glycemic Control in Adults with Type 1 Diabetes Mellitus

Abstract

Basal insulin injections are important for glycemic control in patients with type 1 diabetes mellitus (T1DM); however, patients may forget or skip doses. This study explored the adherence to basal insulin injections and the association of the pattern of missed basal insulin doses with glycemic control in patients with T1DM. A prospective real-world study was conducted in Sweden in patients with T1DM who began using a smart insulin pen for basal and/or bolus insulin administration together with their usual continuous glucose monitoring (CGM). This analysis included adults receiving basal insulin degludec, with at least one 14-day period with ≥70% CGM coverage. Outcomes aggregated over each 14-day period included: number of missed basal insulin doses (≥40 hrs between doses), time in range (TIR 70­-180 mg/dL), time above range (TAR level 1 >180-250 mg/dL; level 2 >250 mg/dL), time below range (TBR level 1 54-<70 mg/dL; level 2 <54 mg/dL), mean glucose level, glucose management indicator (GMI) and coefficient of variability (%CV). Data were analyzed by mixed models with patient ID as random effect. Overall, 32 patients (mean age, 35.6 yrs) had 315 14-day periods of acceptable CGM coverage. The probability that a patient missed ≥1 basal insulin dose over a 14-day period was 22% and patients with high %CV had a higher probability (47%) of having a missed dose. Each missed basal insulin dose over a 14-day period was associated with a significant reduction in TIR (−2.61% [−0.63 hrs], p <0.001) and a corresponding statistically significant increase in TAR level 2 (+2.89% [+0.69 hrs], p <0.001), mean glucose level (+7.9 mg/dL, p <0.001) and GMI (+0.19%, p <0.001); no significant association was found with %CV, TBR or TAR level 1. This study demonstrates that missed basal insulin injections are associated with changes in TIR and GMI; as such, there is a significant need for tools, such as smart pens that provide downloadable data, to empower patients to improve insulin adherence. Disclosure N. Rajamand ekberg: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Novo Nordisk, Sanofi, Other Relationship; Self; Boehringer Ingelheim (Canada) Ltd., Novo Nordisk. N. V. Hartvig: Research Support; Self; Novo Nordisk A/S, Stock/Shareholder; Self; Novo Nordisk A/S. A. Kaas: Employee; Self; Novo Nordisk A/S, Stock/Shareholder; Self; Novo Nordisk A/S. J. Moller: Employee; Self; Novo Nordisk A/S, Stock/Shareholder; Self; Novo Nordisk A/S. A. M. Mårdby: Employee; Self; Novo Nordisk A/S, Stock/Shareholder; Self; Novo Nordisk A/S. P. Adolfsson: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Other Relationship; Self; Dexcom, Inc., Glooko, Inc., Novo Nordisk, Tandem Diabetes Care.