Behaviours, thoughts and perceptions around mealtime insulin usage and wastage among people with type 1 and type 2 diabetes mellitus: A cross-sectional survey study

Aims: People with diabetes who use mealtime insulin (MTI) were surveyed about insulin wastage and injection habits when insufficient insulin remains in a disposable prefilled pen/cartridge to administer a full dose in a single injection. Methods: Cross-sectional, online, self-reported survey of MTI usage/wastage behaviour in 400 adults with type 1 (n = 120) or type 2 (n = 280) diabetes mellitus administering > 20 units/day of MTI via 100 units/ml prefilled pens/cartridges for >= 1 month, conducted in France, Germany, Italy and UK. Results: Participants' mean +/- standard deviation age was 54.5 +/- 12.2 years, body mass index was 29.9 +/- 7.2 kg/m(2) and duration of MTI therapy was 8.6 +/- 7.8 years. They administered 3.7 +/- 5.9 injections/day with meals, using 11.3 +/- 18.0 prefilled pens/cartridges per month. Overall, 63.5% split the dose across two prefilled pens/cartridges (i.e. administered two injections to obtain a full dose), 15.0% used just what remained in their current pen (i.e. took a lower-than-prescribed dose) and 36.3% discarded prefilled pens/cartridges still containing insulin (i.e. took full dose with new pen). The latter participants discarded a mean 5.5 +/- 8.2 prefilled pens/cartridges monthly still containing insulin, each containing 8.6 +/- 8.7 units of insulin. Participants who wasted insulin considered it frustrating, time-consuming and painful to inject twice. Conclusions: Patients taking > 20 units/ day MTI can find transitions between insulin pens challenging. This study highlights the need to identify ways of improving transitions between pens to make transitions easier for insulin users, which could potentially improve adherence to prescribed doses and reduce waste. (C) 2016 Eli Lilly and Company. Published by Elsevier Ireland Ltd.