Insulin Pen Research Articles

Determinants of Self-monitoring of Blood Glucose in Iranian Children and Adolescents with Type 1 Diabetes.

Type 1 diabetes mellitus (T1DM) is a prevalent chronic disease among children and adolescents, necessitating effective self-monitoring of blood glucose (SMBG) levels. Understanding the determinants and factors influencing SMBG behavior is crucial for optimizing diabetes management in this population. This study aimed to investigate the frequency of SMBG and identify the determinants influencing factors in children and adolescents with T1DM. This cross-sectional study was conducted in Tehran, Iran, and included 275 participants selected through simple random sampling from the Gabric Diabetes Education Association. The inclusion criteria comprised children and adolescents aged 3 - 18 years diagnosed with T1DM for at least 6 months who were using analog or neutral protamine Hagedorn (NPH) and regular insulin subcutaneously. Patients using insulin pumps were excluded. Data collection involved an online questionnaire covering demographic information (e.g., age, gender, educational status, and parental occupations) as well as clinical information (number of hypoglycemic episodes, hemoglobin A1C (HbA1C) levels, diabetes duration, insulin regimen, diabetes complications, glucose monitoring practices, hospitalizations, and behavioral characteristics). Statistical analyses, including descriptive statistics, correlation tests, and Poisson regressions, were performed using SPSS software (version 21). A significance level of P-value < 0.05 was considered statistically significant. The participants had a mean age of 10.00 ± 3.77 years, with 54.2% being males. Most of the participants (87.3%) were schoolchildren, and the mean age of diagnosis was 6.56 ± 3.73 years, with a mean duration of 44.72 ± 36.32 months. Anthropometric investigations revealed mean height, weight, and body mass index (BMI) values of 136.69 ± 21.11 cm, 37.45 ± 15.51 kg, and 18.31 ± 3.55 kg/m2, respectively. The majority of participants (93.5%) used insulin pens, and the mean daily insulin dosage was 35.34 ± 22.20 IU. Parents reported consistent glucose level monitoring in 64.7% of cases. The mean HbA1c level was 7.91 ± 1.58%. Factors such as the price and availability of glucometer strips influenced glucose level monitoring. In univariate analysis, only age and HbA1C levels showed a negative correlation; however, parents' consistent checking showed a positive correlation with the frequency of daily, weekly, or monthly glucose checking. This study underscores the significance of SMBG in children and adolescents with T1DM. The findings emphasize the critical role of price and availability of glucometers and strips in achieving standard care for T1DM patients.

European Survey on Adult People With Type 1 Diabetes and Their Caregivers: Insights Into Perceptions of Technology.

Type 1 diabetes (T1D) is a complex condition requiring constant monitoring and self-management. The landscape of diabetes management is evolving with the development of new technologies. This survey aimed to gain insight into the perceptions and experiences of people with T1D (PWD) and their caregivers on the use of technology in diabetes care, and identify future needs for T1D management. PWD and caregivers (≥18 years) living in five European countries (France, Germany, Italy, Spain, and the United Kingdom) completed an online survey. Data were collected during July and August 2021. Responders included 458 PWD and 54 caregivers. More than 60% of PWD perceived devices/digital tools for diabetes management as useful and 63% reported that access to monitoring device data made their life easier. Nearly half of participants hoped for new devices and/or digital tools. While approximately one-third of all PWD had used teleconsultation, perceptions and usage varied significantly between countries and by age (both P < .0001), with the lowest use in Germany (20%) and the highest in Spain (48%). The proportions of PWD contributing to diabetes care costs varied by device and were highest for smart insulin pen users at 83% compared with 44% for insulin pen users and 37% for insulin pump users. One-quarter (24%) of PWD and 15% of caregivers felt they lacked knowledge about devices/digital tools for T1D. Most PWD and caregivers had positive perceptions and experiences of new technologies/digital solutions for diabetes management, although improved support and structured education for devices/digital tools are still required.

Evaluating a systematic intensive therapy using continuous glucose monitoring and intermittent scanning glucose monitoring in clinical diabetes care: a protocol for a multi-center randomized clinical trial.

As many people with type 1 diabetes find it hard to reach the recommended glycemic goals, even with CGM, this study aims to determine if a closer, digitally supported collaboration on interpreting CGM data together with a diabetes nurse can improve glycemic control. A total of 120 individuals, 18 years and older and with HbA1c ≥ 58 mmol/mol will be included in the study at 8 different sites in Sweden and Norway. To be included, the participants must use a CGM or isCGM and be able to upload the data to the appropriate online service for their clinic and sensor. Both those with insulin pumps and insulin pens will be included in the study. Participants will be randomized into two different groups, that is, the intensive therapy group and the control group. The intensive therapy group will upload their glucose data weekly for the first 4 months and have telephone contact with their diabetes care team to receive support in interpreting CGM data and taking appropriate actions if their mean blood glucose level is above 8.4 mmol/L. After the 4-month-long intensive treatment phase, both randomized groups will have the same number of clinical visits and receive the same type of diabetes support. It is of great importance to find new ways to help people with type 1 diabetes manage their condition as well as they can to help them achieve better glycemic control so that hopefully more people can achieve the recommended glycemic goals, which are associated with fewer diabetes complications. If it is shown that people with type 1 diabetes achieve better glycemic control with intensive therapy, then this can be incorporated into clinical praxis as an option for those not currently reaching the recommended glycemic goals. https://clinicaltrials.gov/study/NCT03474393?locStr=Uddevalla,%20Sweden&country=Sweden&distance=50&cond=Diabetes&aggFilters=ages:adult%20older&state=V%C3%A4stra%20G%C3%B6taland%20County&city=Uddevalla&page=4&rank=34, identifier 03474393.

Glucagon-like Peptide-1 Receptor Agonist Treatment in Type 1 Diabetes

Type 1 diabetes (T1D) is characterized by a progressive decline of insulin production due to a marked destruction of pancreatic B cells. Intensive insulin therapy is the pillar of T1D management. More recently, continuous glucose monitoring devices, closed-loop systems (CLS) and smarter connected insulin pen systems have all significantly helped individuals to improve glycemic control. Despite these advances, however, more than three-quarters of the adult T1D population does not achieve recommended glycemic targets. In addition, aggressive insulin intensification potentiates weight gain and the risk of recurrent hypoglycemic events. Recent significant increase in rates of obesity has also led to a sharp increase in T1D patients who concurrently have adiposity-based chronic disease, increasing their insulin resistance and predisposition for cardiovascular events. While insulin will remain the basis of T1D management, there is an unmet need for individualized adjunctive therapeutic approaches focusing on the prevention of diabetic complications in addition to glycemic control. One such adjunctive therapy currently being explored in T1D are the glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a popular and robust approach in Type 2 diabetes (T2DM) to mimic the natural endogenous GLP-1 incretin. This brief review will focus on the rationale and existing evidence for the use of GLP-1 RAs in the management of T1D.

SAT133 A Case Study Of UX/UI Design Diabetes Medication Discharge Orderset: An Initiative To Reduce Discharge Prescribing Error

Abstract Disclosure: E. Yunasan: None. J. Park: None. R. Reddy: None. M. Pennant: None. Prescribing errors involving diabetes medications on discharge are common. The complexity of prescribing insulin, especially due to multiple insulin preparations and supplies contributes to these errors. For example, In our teaching hospital between 01/2021-06/2021, among 40 patients with diabetes mellitus (DM) that were discharged home with insulin, 22 patients (55 %) were discharged without or with incorrect insulin supplies. Well-designed order -set has the potential to reduce the potential of medication errors. Here we present a case study of utilizing FIGMA prototyping software to design a new insulin discharge order set. FIGMA is a web-based user interface design tool, that enables multiple parties to collaborate and work on user experience (UX) and User Interface (UI) prototyping. The aim of this case study is to explore design considerations using FIGMA software for establishing a patient-centered, and user-friendly insulin discharge order set involving multiple stakeholders in the hospital including residents, diabetes educators, attendings, pharmacists, and endocrinologists. We conducted multiple prototyping sessions using FIGMA software. Each participant is able to work simultaneously on the discharge order set together in real-time. The prototyping sessions result in a new discharge order set, which focused on simplicity and provider efficiency in the hope to reduce prescribing errors. Here we outline the advancement in order set design. The previous order set presents 20 different types of insulin pens/syringes that are listed together with a blood glucose meter, testing strips, lancets, alcohol pads, and a lancet device. After that, providers have to manually enter the order for insulin separately. In the new order set, providers will only see 2 options, “Patient uses insulin pen”, and “Patient uses vial and syringe”. When providers choose, “Patient uses insulin pen”, the new order set would automatically pre-selected the options for insulin pen, pen needle, glucometer, testing strips, lancets, and alcohol swabs. Testing supplies options come with default instructions and prefilled quantities. Options for endocrinology, diabetes educator and transitional care referrals are also automatically pre-selected. Additional orders such as metformin, GLP-1 agonist, and SGLT-2 inhibitors are presented as options. Alternatively, if providers choose the insulin syringe option, the order set would look similar, except the order set would present pre-selected options for insulin vials that are already linked with the correct syringe size. In conclusion, creating an insulin discharge order set using FIGMA is a great way to collaborate with multiple stakeholders. This platform can also be potentially utilized in developing other order sets. Presentation: Saturday, June 17, 2023

THU070 Randomized, Placebo-controlled Phase 3 Trial Protocol Assessing The Efficacy And Safety Of Octreotide Subcutaneous Depot (CAM2029) In Patients With Acromegaly

Abstract Disclosure: D. Ferone: Advisory Board Member; Self; Recordati, Novartis-AAA, Sandoz, Camurus. Grant Recipient; Self; Bristol-Myers Squibb, Novartis-AAA, Ipsen, Camurus. Research Investigator; Self; Camurus. P. Freda: Research Investigator; Self; Camurus. L. Katznelson: Advisory Board Member; Self; Recordati, Camurus, Amryt. Research Investigator; Self; Camurus. F. Gatto: Research Investigator; Self; Camurus. A. Gilis-Januszewska: Research Investigator; Self; Camurus. M.B. Gordon: Advisory Board Member; Self; Camurus, Crinetics, HRA Pharma, Novo Nordisk, Recordati. Grant Recipient; Self; Amryt, Ascendis, Camurus, Corcept, Crinetics, Ipsen, Novartis Pharmaceuticals, Novo Nordisk, Opko, Pfizer, Inc., Strongbridge. Research Investigator; Self; Camurus. P. Kadioglu: Research Investigator; Self; Camurus. P. Maffei: Research Investigator; Self; Camurus. J.R. Seufert: Research Investigator; Self; Camurus. J. Silverstein: Advisory Board Member; Self; Amryt, Recordati. Research Investigator; Self; Camurus. J.L. Spencer-Segal: Grant Recipient; Self; Camurus. Research Investigator; Self; Camurus. M. Harrie: Employee; Self; Camurus. A. Svedberg: Employee; Self; Camurus. F. Tiberg: Employee; Self; Camurus. Extended-release formulations of the somatostatin analogues (SSAs), octreotide and lanreotide, are first-line medical therapies for patients with acromegaly who have contraindications for, or are not cured by, surgical intervention and/or radiotherapy. Treatment goals, regardless of modality, include biochemical normalization of insulin-like growth factor 1 (IGF-1) and growth hormone (GH), symptom relief, tumor control, and maintenance of pituitary function. From the patient perspective, treatment satisfaction, autonomy, and quality of life may be as important as biochemical control. Constraints of current SSA formulations include incomplete biochemical and symptom control, and a lack of convenient self-administration options. Octreotide subcutaneous (SC) depot (CAM2029) is a novel FluidCrystal® formulation of octreotide designed for easy administration by patients, in a ready-to-use prefilled syringe or injection pen. In previous clinical trials, CAM2029 provided more than five-fold higher bioavailability compared to the currently marketed long-acting octreotide formulation.The efficacy and safety of CAM2029 in acromegaly is being evaluated in a 6-month, randomized, double-blind, placebo-controlled phase 3 trial (NCT04076462). 72 patients were randomized 2:1 to monthly SC doses of CAM2029 20 mg or placebo, with the option for self-administration. Key inclusion criteria included a biochemical and clinical diagnosis of acromegaly due to a pituitary adenoma with persistent or recurrent disease, treatment with a stable dose of octreotide long-acting release or lanreotide Autogel for at least 3 months as monotherapy, and controlled disease with IGF-1 ≤1 x upper limit of normal (ULN). Key exclusion criteria included GH ≥2.5 μg/L at screening, pituitary surgery within 6 months of screening, prior pituitary irradiation, and recent treatment with pasireotide, pegvisomant, or dopamine agonists. The primary endpoint is the proportion of patients with normalized IGF-1 (≤1 x ULN) after 6 months of treatment. Other endpoints include change from baseline of IGF-1, GH and patient-reported outcomes (Treatment Satisfaction Questionnaire for Medication, Self-Injection Assessment Questionnaire, Acromegaly Quality of Life Questionnaire, EQ-5D-5L), safety and tolerability, clinical signs and symptoms of acromegaly, use of rescue medication and octreotide pharmacokinetics. The estimated primary completion date for the trial is May 2023. After completing study treatment, patients may switch to open-label treatment in a phase 3 long-term safety and extension trial of CAM2029 (NCT04125836). Presentation: Thursday, June 15, 2023

Addressing Insulin Injection Technique: A Follow-up Study of Canadian Patients with Diabetes.

Proper insulin injection technique is important for optimal glycaemic control, yet patients with diabetes often inject insulin incorrectly. Previous studies identified common errors in insulin injection in Canada, and this article seeks to evaluate the current insulin injection technique practices among patients and explore the effectiveness of feedback and education in improving their technique. The study recruited 147 patients and 16 physicians across Canada to gather insights into current insulin injection practices and education gaps. Eligible patients were people living with diabetes who inject insulin using an insulin pen and pen needles. Eligible physicians, who were unsupported by diabetes educators, completed a practice assessment survey and selected 10 eligible patients to complete a baseline assessment survey. During the patient visit, if an error in the patient's technique was identified, a pop-up knowledge transfer (KT) prompt would appear, providing feedback and information on best practices at the point of care. Follow-up surveys were completed 1-3months later. Physicians reported facing barriers to providing education and feedback, including lack of time and personnel, and lack of effective educational material. Patients demonstrated modest improvements in some injection technique domains at their follow-up visit, including injection force factors, time the needle was held in the skin, pen needle reuse, injection area size, and injection angle. The most common initial mistakes by patients were selecting an area smaller than recommended and not paying attention to the injection force. At the second visit, patients reduced an average of one error in their injection technique. Results showed that basic feedback by their physician during one visit could exert moderate improvements on patients' injection technique. Proper injection technique is critical for diabetes management, and incorporating targeted ongoing education and support can significantly enhance physician practices, ultimately reducing risks and improving outcomes.

Active Labeling Correction of Mealtimes and the Appearance of Types of Carbohydrates in Type 1 Diabetes Information Records

People with type 1 diabetes are required to adhere to their treatment rigorously to ensure maximum benefits. Diabetes tracking tools have played an important role in this regard. Type 1 diabetes monitoring has evolved and matured with the advent of blood glucose monitor sensors, insulin pens, and insulin pump automation. However, carbohydrate monitoring has seen little progress despite carbohydrates representing a major potential disruption. Relying on the modeling of carbohydrate intake using the rate of exogenous glucose appearance, we first present a methodology capable of identifying the type of carbohydrates ingested by classifying them into fast and non-fast carbohydrates. Second, we test the ability of the methodology to identify the correct synchrony between the actual mealtime and the time labeled as such in diabetes records. A deep neural network is trained with processed input data that consist of different values to estimate the parameters in a series of experiments in which, firstly, we vary the response of ingested carbohydrates for subsequent identification and, secondly, we shift the learned carbohydrate absorption curves in time to estimate when the meals were administered to virtual patients. This study validates that the identification of different carbohydrate classes in the meal records of people with type 1 diabetes could become a valuable source of information, as it demonstrates the potential to identify inaccuracies in the recorded meal records of these patients, suggesting the potential abilities of the next generation of type 1 diabetes management tools.

Insulin Therapy for the Management of Diabetes Mellitus: A Narrative Review of Innovative Treatment Strategies.

The discovery of insulin was presented to the international medical community on May 3, 1922. Since then, insulin has become one of the most effective pharmacological agents used to treat type 1 and type 2 diabetes mellitus. However, the initiation and intensification of insulin therapy is often delayed in people living with type 2 diabetes due to numerous challenges associated with daily subcutaneous administration. Reducing the frequency of injections, using insulin pens instead of syringes and vials, simplifying treatment regimens, or administering insulin through alternative routes may help improve adherence to and persistence with insulin therapy among people living with diabetes. As the world commemorates the centennial of the commercialization of insulin, the aims of this article are to provide an overview of insulin therapy and to summarize clinically significant findings from phase 3 clinical trials evaluating less frequent dosing of insulin and the non-injectable administration of insulin.

Which people with diabetes are treated with a disposable, half-unit insulin pen? A real-world, retrospective, database study in Spain.

Insulin lispro 100 units/mL Jr KwikPen is the first prefilled, disposable, half-unit insulin pen that delivers 0.5-30 units in increments of 0.5 units for the treatment of patients with diabetes. This study describes the profile of patients in Spain who initiated insulin therapy with Jr KwikPen in a real-world setting. This retrospective, observational study based on IQVIA's electronic medical records database included patients with Type 1 (T1D) or Type 2 (T2D) diabetes who initiated therapy with Jr KwikPen between May 2018 and December 2020. Sociodemographic, clinical, and treatment characteristics at treatment initiation were analysed descriptively. A total of 416 patients were included. The main characteristics of the T1D/T2D groups (N = 326/90), respectively were as follows: female sex, 61.7%/65.6%; mean age (standard deviation [SD]), 32.5 (20.7)/55.5 (16.6) years; body mass index, 20.9 (4.2)/25.2 (4.6) kg/m2 (N = 239/77); HbA1c, 7.8 (1.7)%/8.0 (1.5)% (N = 141/64); and presence of diabetes-associated comorbidities, 27.9%/64.4%. Only 32.8% of patients with T1D were < 18 years old. Among Jr KwikPen users, 12.3% (T1D/T2D, 7.7%/28.9%) were ≥ 65 years old, 17.1% patients were newly diagnosed, and 3.8% were pregnant women. The mean (SD) total insulin dose pre-index for T1D/T2D was 43.1 (23.6) and 40.7 (21.6) UI/day, respectively. The mean (SD) insulin dose at the start of Jr KwikPen use was 26.63 (16.56) and 22.58 (13.59) UI/day for T1D/T2D, respectively. Jr KwikPen was first prescribed mainly by endocrinologists (58.7%) or paediatricians (22.6%). The profile of patients who initiated therapy with Jr KwikPen in routine practice was broad with many patients being adults. Most of these patients had T1D, inadequate glycemic control, and multiple associated comorbidities. These results suggest that Jr KwikPen is prescribed in patients who may benefit from finer insulin dose adjustments, namely children, adolescents, adults, older individuals, or pregnant women with T1D or T2D.

Overcoming barriers to technology in special groups

AbstractDiabetes demands a high volume of self‐care and management, which poses many obstacles for those with advanced age, cognitive impairment, or physical disability. The latest diabetes technologies, including smart insulin pens, continuous glucose monitoring and insulin pumps, have great potential to improve glycaemic control and quality of life, particularly for those affected by impairment or disability. Although these groups may face barriers to using diabetes technology, accessing and harnessing the benefits and opportunities of the technologies can be achieved with appropriate support and education. This article explores the role of diabetes technology in the care of individuals in special groups, including those with visual impairment, learning disability, cognitive impairment, or reduced dexterity, and elderly people. Copyright © 2023 John Wiley &amp; Sons.

Modern technologies in dieting and diabetic management

The purpose of this review paper is to investigate the function of new technology in dieting and diabetic care. The paper specifically discusses wearable devices, artificial intelligence, telemedicine, virtual and augmented reality, smart insulin pens and pumps, Internet of Things (IoT) devices, social media, mobile apps, and sensors, as well as their benefits and limitations in diabetes management. Wearable glucose monitoring gadgets, smart insulin pens and pumps, and IoT devices for monitoring and managing food intake and blood sugar levels have all demonstrated encouraging results in diabetes care. Artificial intelligence and machine learning have the ability to help diabetic patients with individualized nutrition suggestions. Telemedicine and remote monitoring have aided in diabetes education and self-management skill training. These technologies, however, have drawbacks such as high costs, limited accessibility, and worries about data privacy and security. Overall, this research emphasizes the significance of modern technology in diabetes care and delves into its potential benefits and drawbacks.

Advantages and disadvantages of connected insulin pens in diabetes management.

Insulin administration remains vital to the treatment of diabetes and although there have been advances in insulin delivery, evidence suggests that many people with diabetes on insulin therapy have suboptimal glycemic management. Recent advancements in insulin administration techniques include connected insulin devices, such as connected insulin pens and pen caps. In this review, we provide an overview of the literature on the use of connected insulin pens and pen caps to further elucidate the clinical benefits and drawbacks of these devices. We discuss the development of these devices, outlining the characteristics of insulin pens and pen caps with regulatory approvals. These devices have different features that can ease the burden of diabetes management, including automatic recording of insulin dose information, tracking of insulin-on-board, bolus calculators, and missed dose alerts. Despite the advantages of connected pens and pen caps, a small percentage of insulin users are currently using these devices, due to many factors, including lack of health-care professional awareness, initial training for prescribers, and setup of the device. Overcoming these barriers and publishing more data demonstrating the glycemic outcomes associated with these systems could improve diabetes management for people living with diabetes. As health-care systems become increasingly digital, connected insulin pens have the potential to allow a data-driven approach to diabetes management for people who are not interested in, cannot afford, or do not have intensive insulin regimens that might warrant use of insulin pumps or automated insulin delivery systems.

How to Effectively Integrate Smart Insulin Pens in Clinical Practice Using the Identify-Configure-Collaborate Framework

How to Effectively Integrate Smart Insulin Pens in Clinical Practice Using the Identify-Configure-Collaborate Framework

Needlestick Injuries With Insulin Injections: Risk Factors, Concerns, and Implications of the Use of Safety Pen Needles in the Asia-Pacific Region.

Globally, health care workers (HCWs) are at a high risk of occupational exposure to needlestick injuries (NSIs). Needlestick injuries not only are associated with an increased risk of infections caused by bloodborne pathogens but are also a primary source of emotional distress and job burnout for HCWs and patients. Insulin injection-related NSIs are common among HCWs working in hospitals in the Asia-Pacific (APAC) region and impose a significant burden. Insulin pen needles have a high risk of transmitting infections (at both the patient-end and cartridge end of the sharp) after use. Recapping a needle after administering an insulin injection poses a major risk to HCWs. Currently, several safety-engineered needle devices (SENDs) are available with active or passive safety mechanisms. Passive insulin safety pen needles with dual-ended protection and automatic recapping capabilities have resulted in a significant drop in accidental punctures to HCWs while administering insulin to patients with diabetes. In this article, we have reviewed the burden and common causes of NSIs with insulin injections among HCWs in the APAC region. We have discussed current approaches to address the issues associated with NSIs and the benefits of introducing SENDs in health care settings, including long-term care facilities, nursing homes, and home care settings where patients may require assisted insulin injections. This review also summarizes key strategies/recommendations to prevent NSIs in HCWs and patients with diabetes in the APAC region.

Leading with the trailing edge: facilitating patient choice for insulin products

Abstract Insulin prices have risen sharply, despite a century since its introduction. Against this backdrop, companies have discontinued dozens of insulin products. Discontinuation could relate to safety or effectiveness, or to the overwhelming benefits of newer products. On the other hand, discontinuation could suggest strategic behavior hampering competition and supporting prices. To test these theories, this project examined every insulin discontinuation, analyzing the role discontinuations play in insulin affordability. No evidence emerged of any discontinuation for safety or effectiveness. Rather, dozens of viable products were removed from the market, followed by more expensive versions, often with little or no clinical improvement. Insulin pens with a phone app may provide advantages, for example. However, for older patients, who may find the technology confusing, or for patients with budget constraints, the value proposition falters. Moreover, discontinuation blocks biosimilars from market entry because they cannot demonstrate biosimilarity without the drug. The problem exists for all biosimilars. If there are willing buyers and willing sellers of clinically effective products that are off-patent, entry should be facilitated. This article suggests a requirement that companies deposit samples at the time of FDA approval, laying the groundwork for later entry of trailing-edge products with clinically viable outcomes.

Diagnostic Challenge of Adult-onset Type 1 Diabetes Mellitus in a Remote Hospital

Type 1 Diabetes Mellitus (T1DM) is a chronic endocrinological disease due to an autoimmune process. The prevalence of T1DM is 9.5% worldwide, with the incidence of 15 out of 100,000 people, ranging from childhood to 40 years of age. Autoimmunity-related late-onset Diabetes Mellitus (DM) patients could be diagnosed as classic T1DM or latent autoimmune diabetes in adults (LADA). A 30-year-old male patient with unremarkable previous medical history was admitted to the emergency room with dyspnea for the last three days that was worsened six-hour before admission. Physical examinations showed a body Mass Index (BMI) of 18.75 kg/m2, irregular pulse, and Kussmaul breathing. The patient was diagnosed with diabetic ketoacidosis (DKA) on May 23, 2019. He was discharged with subcutaneous insulin pen injections. Two years later, he was readmitted with DKA due to discontinuing his treatment. He stated that the reason for stopping the insulin was because he was tired of injecting it. The patient was hospitalized and was discharged with oral antidiabetic agents to cope with his injection tiredness issue. One week later, the patient complained of dyspnea and was diagnosed with recurrent DKA. He was hospitalized and prescribed subcutaneous insulin. In this kind of situation, a diagnosis of LADA for patients presenting with DKA without prior history of DM in early adulthood needs to be considered. In contrast to the classic T1DM, the need for insulin occurs late in LADA. Affordable and widely available ancillary examinations are needed, including in remote hospitals. Finally, motivational support for patients is as important as the pharmacological treatment since lifelong insulin injections are needed.

News in diabetology 2022.

The use of new antidiabetic drugs in clinical practice in the last two decades has completely changed the Type 2 diabetes management. Following the results of new clinical trials, international recommendations for the treatment of diabetes were regularly modified. In the field of Type 1 diabetes, new technologies have appeared, such as smart insulin pens. We can await once weekly insulins and dual GLP-1 and GIP analogues in the near future.

807-P: Patient and Health Care Provider Experiences of Suboptimal Insulin Dosing in the United States

Objectives: This study described the frequency of suboptimal insulin dosing (missed and mistimed doses) and the factors underlying this behavior from the perspective of people with diabetes (PwD) and healthcare professionals (HCPs.) Methods: For this cross-sectional, multinational non-interventional study, 640 HCPs and 1150 PwD (300 with type 1 diabetes, 850 with type 2 diabetes) completed an online survey. A research vendor recruited adult PwD currently using a non-connected insulin pen (400 from US) and eligible HCPs (160 from US) via validated panels, referrals, list acquisition, and custom methods. Results are presented for US data. Results: Overall, 42% and 61% of PwD reported missing basal and bolus insulin doses in the past 30 days. The average number of missed basal and bolus doses were 3.1 (SD=3.81) and 5.0 (SD=10.30), respectively. PwD reported forgetting, being too busy/distracted, and out of my normal routine as key reasons for missed doses. Overall, 37% and 49% of PwD reported mistiming basal and bolus doses, respectively, in the past 30 days. This corresponded to an average of 3.1 (SD=3.29) mistimed basal and 4.9 (SD=6.28) mistimed bolus doses. Key reasons PwD reported for mistimed doses included being too busy/distracted, forgot or having an unexpected or earlier/later-than-expected meal. Conversely, the majority of HCPs reported ≤20% of their PwD missed/skipped a dose in the past 30 days. HCPs reported dosing reminders (90%), automatically recorded insulin doses and timing (92%) and having insulin and glucose data in one place (94%) as identified solutions. Conclusions: PwD are missing, skipping, or delaying their insulin doses, largely for preventable reasons. HCPs perceive PwD dosing adherence greater than PwD self-reported behaviors. Digital health solutions, such as connected insulin pens, may help PwD reduce missed and mistimed doses as well as help close the perception gap to further optimize insulin management. Disclosure M.B.Davidson: Employee; Eli Lilly and Company. F.Gelsey: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. J.Bower: None. E.Artime: None. E.Spaepen: Consultant; Eli Lilly and Company. R.Newson: Employee; Eli Lilly and Company. Funding Eli Lilly and Company

58-OR: Glycemic Impact of Meal-Dosing Behavior in Users of the InPen Smart Insulin Pen (SIP) Paired with Continuous Glucose Monitoring (CGM)

Background: Data from connected insulin pen therapies are revealing both gaps and opportunities to significantly improve care for people on multiple daily insulin injections therapy. This real-world (RW) data analysis reports on the impact of meal-dosing behavior (missed and late) on glycemia in adult and pediatric InPen users with type 1 (T1D) or type 2 diabetes (T2D). Method: The RW data from 5,153 deidentified individuals who used the InPen SIP and CGM for at least 30 days between January 2020 and December 2021, and who had dosing and CGM data between 30 and 59 days since first bolus date, were analyzed using a meal detection algorithm. Users with &amp;lt;14 days of bolus data or inadequate CGM data (&amp;lt;14 days of 70% or more SG data/day) were excluded. Results: The impact of dosing behavior (≤2 versus &amp;gt;3 doses/day) and missed dose frequency (&amp;lt;20% versus ≥20%) on glycemia was analyzed (Table). A dosing frequency of &amp;gt;3 (including correction-only doses) and a missed dose frequency of &amp;lt;20% were associated with improved glycemic metrics. Overall, the frequency of on-time dosing was significantly correlated with user TIR (r=0.59, p&amp;lt;0.001). Conclusion: Real-world InPen with CGM use data provide insights into the impact of meal-dosing behavior on glycemic outcomes, which may inform counseling strategies for care teams and open the door to precision insulin injection management. Disclosure J.Macleod: Employee; Medtronic. M.Smith: Employee; Medtronic. G.Im: Employee; Medtronic. T.L.Cordero: Employee; Medtronic. R.A.Vigersky: Employee; Medtronic.