Autor:innen:
W. Polonsky (San Diego, CA, US)
J. Johnson (Indianapolis, IN, US)
H. Wolpert (Indianapolis, IN, US)
X. He (Indianapolis, IN, US)
C. Kao (Indianapolis, IN, US)
E. Meadows (Indianapolis, IN, US)
J. Poon (Indianapolis, IN, US)
D. Price (San Diego, CA, US)
S. Edwards (Indianapolis, IN, US)
S. Görgens (Bad Homburg, DE)
Objectives: People with diabetes (PwD) when introduced to real-time continuous glucose monitoring (rtCGM) may struggle to meet glycaemic targets, as highlighted by T1D Exchange. We assessed missed bolus doses (MBD) in relation to psychosocial factors and rtCGM use in PwD using insulin. Methods: PwD with HbA1c≥64mmol/mol and taking ≥3 insulin boluses/day were enrolled. We administered the Adult Low Blood Sugar Survey short form (ALBSS) for evaluating hypoglycaemic fear at baseline. Data from a connected insulin pen and CGM (1st 6 weeks blinded, 2nd 6 weeks rtCGM) were used to calculate MBD as defined by 4.44mmol/L glucose increase over ≤2 hours not preceded within 1 hour by insulin dose. Mixed-effect model for repeated measures tested association of MBD with ALBSS. Logistic regression assessed relationship of MBD change (blinded to rtCGM) with ALBSS. Covariates: baseline HbA1c (≤ or >75mmol/mol), diabetes type and duration, sex, ethnicity, age, BMI. Results: Participants (N=68), mean age 48 (range 22-65yrs), were 44% female, 18% Hispanic, 59% T1D. Mean ALBSS score: 13.7 (range 0-34). In the blinded period, a mean of 0.94±0.39MBD/day were calculated, which reduced in rtCGM (0.85±0.37MBD/day, p=0.05). For blinded and rtCGM, more frequent MBD were independently associated with greater hypoglycaemic fear (ALBSS, p=0.04) and higher baseline A1C (p=0.001). Participants with greater hypoglycaemic fear were more likely to miss more bolus doses even after switching to rtCGM (odds ratio 1.1, p=0.045). Conclusions: MBD were relatively common in PwD using multiple daily injections who had not achieved adequate glycaemic control. Hypoglycaemic fear was associated with more MBD, even after introduction of rtCGM. Thus, when managing PwD using bolus insulin, clinicians should address fear of hypoglycaemia as potential barrier to appropriate dosing. This study suggests attention to psychosocial factors and clinician support is required in this population to improve glucose control.