Association between treatment adherence and continuous glucose monitoring outcomes in people with diabetes using smart insulin pens in a real-world setting
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OBJECTIVE: To evaluate the association of insulin injection adherence, smart insulin pen engagement, and glycemic control using real-world data from 16 countries from adults self-administering basal insulin degludec and bolus insulin with a smart insulin pen (NovoPen 6 or NovoPen Echo Plus) alongside continuous glucose monitoring (CGM). RESEARCH DESIGN AND METHODS: Data were aggregated over 14-day periods. Treatment adherence was defined according to the number of missed basal and missed bolus insulin doses and smart pen engagement according to the number of days with data uploads. RESULTS: Data from 3,945 adults, including 25,157 14-day periods with ≥70% CGM coverage, were analyzed. On average, 0.2 basal and 6.0 bolus insulin doses were missed over 14 days. The estimated probability of missing at least one basal insulin dose over a 14-day period was 17.6% (95% CI 16.5, 18.7). Missing one basal or bolus insulin dose per 14 days was associated with a significant decrease in percentage of time with glucose levels in range (TIR) (3.9–10.0 mmol/L), of −2.8% (95% CI −3.7, −1.8) and −1.7% (−1.8, −1.6), respectively; therefore, missing two basal or four bolus doses would decrease TIR by >5%. Smart pen engagement was associated positively with glycemic outcomes. CONCLUSIONS: This combined analysis of real-world smart pen and CGM data showed that missing two basal or four bolus insulin doses over a 14-day period would be associated with a clinically relevant decrease in TIR. Smart insulin pens provide valuable insights into treatment injection behaviors.
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In a recent real-world study with multinational data from 3,954 adults with diabetes using a connected pen and CGM, treatment engagement with a connected insulin pen is positively associated with glycemic outcomes, and missing as little as two basal doses or four bolus insulin doses over a 14-day period is associated with a clinically relevant decrease in time in range of ≥5%.
“A recent realworld study with multinational data collected from 3,954 adults with diabetes using a connected pen and CGM validated the fact that treatment engagement with a connected insulin pen is positively associated with glycemic outcomes.”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [156]
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- Authors
- Danne, T. P. A., Joubert, M., Hartvig, N. V., Kaas, A., Knudsen, N. N., & Mader, J. K.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- 2Diabetes Care Unit, Caen University Hospital, University of Caen Normandy, Caen, France
- Novo Nordisk (Denmark) (DK)
- Medical University of Graz (AT)
- Corresponding author
- Danne, Thomas P.A.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2024-04-03
- Volume
- 47
- Issue
- 6
- Pages
- 995-1003
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC11116913
- OpenAlex
- W4393853146
- Cited by
- 42
- References
- 29
- Citations by year
- 2026: 15 · 2025: 17 · 2024: 10
- FWCI
- 13.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Novo Nordisk A/S
- 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
- medication adherence, smart insulin pens, continuous glucose monitoring, glycemic control, bolus insulin, time in range
- MeSH terms
- Treatment Adherence and Compliance, Continuous Glucose Monitoring, Adult, Aged, Blood Glucose, Diabetes Mellitus, Diabetes Mellitus, Type 1, Female, Humans, Hypoglycemic Agents, Insulin, Male, Middle Aged, Blood Glucose Self-Monitoring, Insulin, Long-Acting
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