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Cited by 77Medication Adherence and ComplianceDiabetes Management and EducationDiabetes Management and Research

A Systematic Review of Insulin Adherence Measures in Patients with Diabetes

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Stolpe, Samuel, Kroes, Michel A., Webb, Neil, Wisniewski, Tami·2016·Journal of Managed Care & Specialty Pharmacy
DOI 10.18553/jmcp.2016.22.11.1224PMC PMC10398138
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Abstract

BACKGROUND: Diabetes care is associated with a considerable burden to the health care system in the United States, and measuring the quality of health care is an important development goal of the Department of Health and Human Services and the Centers for Medicare & Medicaid Services. Diabetes is a priority disease within the National Quality Strategy and should therefore remain a focus in the measurement of health care quality. Despite the importance of measuring quality in diabetes care management, no quality measure is currently associated with adherence to insulin treatment, and measuring adherence to insulin is known to be complicated. OBJECTIVES: To (a) identify methods to measure insulin adherence in patients with diabetes and (b) evaluate whether identified methods could be considered for testing as a quality measure. METHODS: Systematic searches were conducted in the online electronic databases Embase, MEDLINE, and the Cochrane Library, supplemented with additional manual searches to identify publications on insulin adherence from the year 2000 onward. Identified citations were screened for relevance against predefined eligibility criteria, and methods to measure adherence to insulin were extracted from relevant studies into data extraction tables. Methods were critiqued on the feasibility for consideration as a quality measure. RESULTS: Seventy-eight publications met the inclusion criteria and were reviewed. Included studies reported various indirect methods to measure adherence to insulin, using prescription claims or self-report questionnaires. Commonly reported methods included the (adjusted) medication possession ratio, proportion of days covered, persistence, daily average consumption, and the Morisky Medication Adherence Scale. All types of identified methods were associated with measuring challenges varying from accuracy of estimated adherence, complexity of data collection, absence of validated threshold for good adherence, and reliability of adherence outcomes. CONCLUSIONS: Without additional research, none of the identified methods are appropriate for use as a quality measure for insulin adherence. We suggest patient involvement in future research and additional quality measure development. DISCLOSURES: Novo Nordisk paid DRG Abacus to complete the systematic review and manuscript and was involved in the study design, interpretation of data, and decision to publish the findings of the systematic review. Kroes and Webb report personal fees from Novo Nordisk during the conduct of the study and personal fees from DRG Abacus, outside of the submitted work. Webb is employed by DRG Abacus, and Kroes was employed by DRG Abacus at the time of this study. Wisniewski is an employee of Novo Nordisk, which funded the systematic review reported in this article, and also owns stocks in Novo Nordisk. Stolpe has nothing to disclose. Study concept and design were contributed by Kroes, Webb, and Wisniewski, with assistance from Stolpe. Webb took the lead in data collection, along with Kroes, and data interpretation was performed by all the authors. The manuscript was written by Kroes, Webb, and Wisniewski, with assistance from Stolpe, and revised by Kroes, Stolpe, Wisniewski, and Webb.

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  • Poor adherence to insulin administration is common in patients with diabetes, with up to half reporting poor adherence and one-third reporting insulin omission.

    “Among factors that could explain the low rate of optimal response to insulin therapy, poor adherence to insulin administration has been reported in up to half of patients with diabetes,7-9 with one-third of patients reporting an average of 3 episodes of insulin omission within the previous month.8,10”

    From Efficacy of a Smart Insulin Pen Cap for the Management of Patients with Uncontrolled Type 2 Diabetes: A Randomized Cross-Over Trial (2023) · cites this paper as [7]

    The introduction (section D; page not supplied) says poor adherence to insulin regimens is common in people with diabetes. It does not give the claimed figures of up to half reporting poor adherence or one-third reporting an average of three omissions in the previous month. (LLM, conf=0.86)

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  1. complian* or adheren* or concordan* or persisten*).ti,ab. 465,434 4 or/1-3 492,430 5 exp Diabetes Mellitus/ 330,360 APPENDIX Systematic Review Search Strings (continued) Update Search Strings Searched June 29, 2015 Ovid MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE 1946 to Present Results 6 exp Diabetes Mellitus, Type 1/ 63,710 7 insulin dependent diabetes.mp. 19,960 8 T1DM.mp. 2,351 9 (diabetes mellitus and (type 1 or type i or type one)).ti,ab. 15,203 10 (type 1 diabetes or type i diabetes).ti,ab. 30,768 11 exp Diabetes Mellitus, Type 2/ 92,365 12 insulin independent diabetes.ti,ab. 128 13 non insulin dependent diabetes mellitus.ti,ab. 6,718 14 (diabetes mellitus and (type 2 or type ii or type two)).ti,ab. 33,755 15 (type 2 diabetes or type ii diabetes).ti,ab. 80,905 16 NIDDM.ti,ab. 6,820 17 ((adult onset or adult-onset) and diabetes).mp. 943 18 or/5-17 364,040 19 exp Insulin/ 161,622 20 insulin*.ti,ab. 289,790 21 human insulin.mp. 5,407 22 exp Biphasic Insulins/ 153 23 biphasic insulin.mp. 566 24 bovine insulin.mp. 807 25 exp Insulin, Short-Acting/ 1,210 26 short acting insulin.mp. 384 27 rapid acting insulin.mp. 476 28 intermediate acting insulin.mp. 238 29 long acting insulin.mp. or exp Insulin, Long-Acting/ 3,290 30 pre-mixed insulin.mp. 21 31 humalog.mp. or exp Insulin Lispro/ 796 32 exp Insulin Aspart/ 513 33 (novolog or novorapid).mp. [mp = title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier] 56 34 apidra.mp. 20 35 regular humulin.mp. 1 36 novolin.mp. 21

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Authors
Stolpe, S., Kroes, M. A., Webb, N., & Wisniewski, T.
Affiliations
  • Pharmacy Quality Alliance (US)
  • DRG Abacus, Bicester, Oxfordshire, United Kingdom.
  • Novo Nordisk, Plainsboro, New Jersey.
ORCID
Venue
Journal of Managed Care & Specialty Pharmacy
Publisher
Academy of Managed Care Pharmacy
Published
2016-11
Volume
22
Issue
11
Pages
1224-1246
ISSN
  • 2376-0540 (ISSN-L)
  • 2376-1032
DOI
10.18553/jmcp.2016.22.11.1224
PMC
PMC10398138
OpenAlex
W2546079515
Cited by
77
References
109
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 11 · 2022: 11 · 2021: 10 · 2020: 14 · 2019: 11 · 2018: 7 · 2017: 2
FWCI
1.17
Type
journal article
Language
en
Open access
Locations
  • Journal of Managed Care & Specialty Pharmacy (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
insulin adherence, diabetes mellitus, quality metrics, medication adherence measurement, medication possession ratio, proportion of days covered, persistence, Morisky Medication Adherence Scale, prescription claims, self-report questionnaire, adherence thresholds, quality of care measurement, patient involvement, patient-reported outcomes
MeSH terms
Diabetes Mellitus, Humans, Insulin, Quality of Health Care, United States, Databases, Factual, Medication Adherence

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