OBJECTIVES: This study aimed to understand the extent of suboptimal insulin dosing (missed and mistimed doses) and the factors underlying this behaviour from the perspective of people with diabetes (PwD) and healthcare professionals (HCPs).

METHODS: For this cross-sectional, multinational non-interventional study, 640 HCPs and 1150 PwD (300 with type 1 diabetes, 850 with type 2 diabetes) completed an online survey. A research vendor recruited adult PwD currently using an analogue insulin pen (350 from the UK, 400 from Germany, 400 from the US) and eligible HCPs (160 each from the UK, Germany, the US, and Spain) via validated panels, referrals, list acquisition, and custom methods.

RESULTS: Overall, 48% and 56% of PwD reported missing basal and bolus insulin doses, respectively, in the past 30 days. Among those who reported missing doses, this corresponded to a missed average of 3.6 (SD=3.61) basal doses and 4.8 (SD=8.29) bolus doses. PwD reported forgetting, being too busy/distracted, and finding it too complicated/burdensome as key reasons for missed doses. Overall, 46% and 40% of PwD reported mistiming basal and bolus doses, respectively, in the past 30 days. Among those who reported mistiming doses, this corresponded to an average of 3.9 (SD=3.95) basal and 5.1 (SD=8.13) bolus doses. Key reasons PwD reported for mistimed doses included being too busy/distracted, being out of routine, or having an unexpected or earlier/later-than-expected meal. In general, HCPs anticipated fewer than 20% and fewer than 30% of PwD were missing basal and bolus doses, respectively.

CONCLUSIONS: PwD are missing, skipping, or delaying their insulin doses, largely for preventable reasons. There is somewhat of a disconnect between HCP perception and actual self-reported dosing behaviours. Platforms that can help increase the objectivity of dose measurements for both PwD and HCPs and that can increase communication surrounding this may help reduce suboptimal insulin dosing.