How Much Do Forgotten Insulin Injections Matter to Hemoglobin A1c in People with Diabetes? a Simulation Study
Open accessAbstract
Background: Forgotten or omitted insulin injections are an important contributing factor to poor glycemic control in people with type 1 diabetes. This study uses mathematical modeling and examines the impact on hemoglobin A1c (HbA1c) levels if insulin injections are forgotten. The simulation concerns people with type 1 diabetes on intensive insulin therapy. Methods: Five sets of blood glucose profiles with and without a forgotten injection were obtained. The difference to HbA1c was calculated using an HbA1c estimator on the profiles and was multiplied by the frequency of forgotten events. A frequency of 2.1 forgotten injections per week was found in the literature. Results: Calculations showed that forgetting 2.1 meal-related injections per week would lead to an increase in HbA1c of at least 0.3–0.4% points, and similarly 0.2–0.3% points related to forgotten injections of the long-acting insulin. In case of even more pronounced nonadherence (e.g., if 39% of all injections are forgotten) there is a possible increase of HbA1c of 1.8% points. Conclusions: The magnitude of the possible improvement in HbA1c agrees well with other studies in the relation between adherence and HbA1c levels. The estimated numbers suggest that missing injections are an important reason for suboptimal treatment.
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Research from individuals using multiple daily injection therapy with continuous glucose monitoring and connected insulin pen or cap devices revealed that missed, mistimed, and mismatched insulin bolus doses are common and occur in both older and younger populations with T1D or T2D, and are associated with higher A1C.
“Research from individuals using MDI therapy with CGM and connected insulin pen or cap devices revealed that missed, mistimed, and mismatched insulin bolus doses are common and occur in both older and younger populations with T1D or T2D, and are associated with higher A1C.13–18”
From Shining the Spotlight on Multiple Daily Insulin Therapy: Real-World Evidence of the InPen Smart Insulin Pen (2024) · cites this paper as [16]
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Experimental — accuracy not yet measuredMissed insulin injections impact HbA1c levels and lead to an increased risk of diabetes-related complications.
“The impact of missed insulin injections on HbA1c levels is well established,7–12 leading to an increasing risk of diabetes-related complications.13,14”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [7]
Studies have found significant correlations between HbA1c levels and the number of missing bolus injections.
“Studies have found significant correlations between HbA1c levels and the number of missing bolus injections.7,39”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [7]
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- Authors
- Randløv, J., & Poulsen, J. U.
- Affiliations
- Novo Nordisk (Denmark) (DK)
- Corresponding author
- Randløv, Jette
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2008-03
- Volume
- 2
- Issue
- 2
- Pages
- 229-235
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC2771482
- OpenAlex
- W2099643467
- Cited by
- 61
- References
- 15
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 5 · 2022: 5 · 2021: 2 · 2020: 6 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 5 · 2015: 1 · 2014: 9 · 2013: 7 · 2012: 8
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- type 1 diabetes, HbA1c, glycemic control, intensive insulin therapy, long-acting insulin, mealtime insulin, blood glucose profiles, HbA1c estimation
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