Assessment of basal insulin adherence in people with type 2 diabetes in telemonitoring: post-hoc analysis of novel data modalities including insulin injection data

Aims: Adherence in people with insulin-treated type 2 diabetes (T2D) is not well understood despite it being a prerequisite for preventing complications. This study used insulin injection data from connected insulin pens to examine adherence and characteristics of people with insulin-treated T2D in telemonitoring.

Methods: Data from 165 participants were included. We applied a three-step methodology to assess overall adherence, adherence distribution, and dose deviation, using injection data recorded by a connected insulin pen. Additionally, statistical tests were performed to evaluate differences in characteristics between adherent and non-adherent participants.

Results: Weekly averaged overall adherence levels ranged between 70.6 % and 79.3 %. Deviation from the recommended dose occurred in 98.8 % of participants, primarily as increased or reduced doses. Non-adherent participants had higher HbA1c (OR = 0.96, 95 % CI = 0.93, 0.99), and total daily insulin dose (OR = 0.99, 95 % CI = 0.98, 0.99), and a lower level of physical activity (OR = 2.55, 95 % CI = 1.23, 5.28) compared to adherent participants.

Conclusions: Utilizing insulin injection data our results provide detailed insights into basal insulin adherence behavior, including irregularities and daily dose adjustments. Our findings are necessary for supporting healthcare providers' preventable efforts and optimizing diabetes care.