Assessing patient preference for insulin intensification in France

Objectives: The progressive nature of Type 2 diabetes mellitus (T2DM) requires periodic intensification of therapy to maintain optimal glycaemic control. Patient perception and apprehension can limit treatment success. This study aimed to evaluate attitudes of patients in France towards intensification strategies and determine reasons for hesitation when switching from basal to basal-bolus or premix insulin. Methods: Participants were recruited through a representative insulintreated T2DM panel in France. Data collected using an electronic web-based questionnaire included demographics, current regimen and preference/perceptions on intensification. Data analysis was conducted in SAS. Results: Mean demographics for the 302 recruited patients included age of 50 years, body mass index of 29kg/m2, and 6 years duration of insulin treatment. A total of 137 (45%) used basal insulin only, 71 (24%) short-acting only (bolus), 73 (24%) basal-bolus, 16 (5%) premix, and 5 (2%) other regimens. 89% of all respondents tested their blood glucose ≤ 4 times daily. Of those on basal-only 31% (42/137) had tried other regimens: 33% (14/42) basal-bolus and 43% (18/42) premix. Reasons for reverting to basal-only included: weight gain (7% basal-bolus; 44% premix); too many injections (7%, 39%); increased risk of hypoglycaemia (14%, 11%) with 43% switching from basal-bolus due to dosing complexity. 58% of respondents on basal-only insulin would hesitate to an extent if asked by their health care professional to add bolus insulin or switch to premixed insulin; 30% were unsure. Reasons for hesitation included: more daily injections (42%), injection associated pain/discomfort (27%), risk of hypoglycaemic events (23%), weight gain (30%), difficulty in determining the correct dose related to food (34%), and the inconvenience of timing (15%). Conclusions: Patient barriers may exist due to associated adverse outcomes, triggering treatment-intensification inertia and leaving many patients under poor glycaemic control. New strategies requiring fewer injections and with less hypoglycaemia could offer a suitable alternative.