Key differences with hypoglycaemic fear in people using insulin: the association with missed bolus doses exists for T2 D, but not T1D

Background and aims Connected insulin pens can assess missed bolus doses (MBD) and their impact on glycemic outcomes. We determined the relationship of MBD to time-in-range (TIR) and explored psychosocial factors associated with MBD.

Materials and methods This observational study enrolled people with T1 D or insulin-using T2 D (A1C≥8 %, ≥3 insulin boluses / day) and administered Hypoglycaemic Fear Survey (HFS) at baseline. MBD was calculated with connected pen and blinded CGM data with varying parameters. MBD was defined as no insulin dose from 2 hours prior to 4 hours after start of glucose excursion (> 70 mg / dl rise in glucose not preceded by hypoglycaemia [< 70mg / dL]). We fitted negative binomial models (with MBD / day as outcome) and performed model selection by Bayesian information criteria (BIC).

Results Mean age 48 years, 44 % female; 65 % had A1C≥9.0 %. T1D(n = 40) and T2D(n = 28) participants differed on age, BMI, and diabetes duration. Participants had mean 0.72 MBD / day (range 0-1.86). TIR was 42.6 % ( ± 18.8 %) (MBD negatively associated [rS=-0.28, p = 0.02]), time-above-range (TAR) was 52.8 % ( ± 21.3 %) (MBD positively associated [rS = 0.26, p = 0.03]).

For T2 D participants, MBD / day were significantly more common with: lower Worry (HFS-W [IRR = 0.94, p = 0.004]), higher Avoidance (HFS-A [IRR = 1.14, p = 0.005]), and higher Maintain High (HFS-MH [IRR = 1.07, p = 0.040]). For T1 D participants, no HFS subscales were associated with MBD / day.

Conclusion Reducing MBD may improve TIR, so it is important to understand why people miss doses. Differences between T1 D and T2 D participants regarding association of hypoglycemic fear with MBD frequency were unexpected, and addressing concerns about hypoglycemia, at least for T2 D, may be a worthwhile first step.

Interessenskonflikt

Disclosures: SE, XH, JJ, ESM, WW, and HW are employees and shareholders of Eli Lilly and Company.

Alfonso Ponce-Ibarra is employee of Lilly Deutschland GmbH.

Publication History

Article published online:
06 May 2021