Nonadherence to Insulin Therapy Detected by Bluetooth-Enabled Pen Cap Is Associated With Poor Glycemic Control
Abstract
OBJECTIVE: To objectively evaluate adherence to timing and dosing of insulin by using Bluetooth pen caps and examine factors related to adherence. RESEARCH DESIGN AND METHODS: Bluetooth-enabled insulin pen caps were used in younger (ages 18–35 years) and older (ages ≥65 years) adults on two or more insulin injections per day. RESULTS: We evaluated 75 participants with diabetes, 42 younger (29 ± 4 years) and 33 older (73 ± 7 years). Nonadherence was found in 24% of bolus (Apidra) doses and 36% of basal (Lantus) doses. We divided participants into tertiles on the basis of overall adherence, with the most adherent tertile having 85% dose adherence compared with 49% in the least adherent tertile (P < 0.001). Participants in the most adherent tertile had better glycemic control than those in the least adherent tertile (7.7 ± 1.1% [61 ± 12 mmol/mol] vs. 8.6 ± 1.5% [70 ± 16.4 mmol/mol], P < 0.03). CONCLUSIONS: Nonadherence to insulin dosing and timing can be objectively assessed by Bluetooth pen caps and is associated with poor glycemic control.
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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 [14]
Difficulties with insulin dosing and inaccurate dose timing result in poor glycemic control for people with diabetes.
“Difficulties with insulin dosing and inaccurate dose timing have been shown to result in poor glycemic control for people with diabetes.5,6”
From Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen (2020) · cites this paper as [5]
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Self-citation
- Authors
- Munshi, M. N., Slyne, C., Greenberg, J. M., Greaves, T., Lee, A., Carl, S., Atakov-Castillo, A., & Toschi, E.
- Affiliations
- Joslin Diabetes Center (US)
- Corresponding author
- Munshi, Medha N.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2019-03-12
- Volume
- 42
- Issue
- 6
- Pages
- 1129-1131
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2921048232
- Cited by
- 66
- References
- 6
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 8 · 2023: 15 · 2022: 8 · 2021: 13 · 2020: 7 · 2019: 2
- FWCI
- 7.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- insulin therapy, medication adherence, glycemic control, bolus insulin, basal insulin, type 1 diabetes, type 2 diabetes, older adults, young adults
- MeSH terms
- Insulin Glargine, Adolescent, Adult, Aged, Aged, 80 and over, Blood Glucose, Diabetes Mellitus, Female, Humans, Hypoglycemic Agents, Injections, Insulin, Male, Cohort Studies, Drug Delivery Systems, Drug Monitoring, Young Adult
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