Association Between Treatment Adherence and Continuous Glucose Monitoring Outcomes in People With Diabetes Using Smart Insulin Pens in a Real-World Setting

OBJECTIVE

To evaluate the association between 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 using 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 as the number of missed basal and missed bolus insulin doses; smart pen engagement was the number of days with data uploads.

RESULTS

Data from 3,945 adults who had 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 (95% CI) of missing at least one basal insulin dose over a 14-day period was 17.6% (16.5%, 18.7%). Missing one basal or bolus insulin dose per 14 days was associated with a significant decrease in percentage (95% CI) of time in range (TIR; 3.9–10.0 mmol/L) of −2.8% (−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.