Connected insulin pens may reduce treatment burden for people with diabetes (PwD) by automatically recording and integrating insulin dosing information with relevant data from other devices (e.g. glucose monitor). This study elicited preferences of PwD for connected pens and associated mobile applications. A literature review and patient interviews informed an online survey in the US and UK, which included a video-introduction to connected insulin pens, a discrete choice experiment (DCE), and background questions. Within the DCE interim analyses, PwD repeatedly chose between a standard pen and two connected pens described by five attributes: 1) device type (i.e. attached vs integrated Bluetooth® transmitter); 2) dosing support services; 3) glucose monitoring support; 4) additional features (i.e. physical activity and dietary trackers); and 5) data sharing functions. A logit model was used to estimate relative attribute importance (RAI) scores. Predicted choice probabilities (PCPs) were obtained for 15 specifications of insulin pens and corresponding mobile applications. 143 T1DM PwD (US: 64; UK: 79) and 361 T2DM PwD (US: 248; UK: 113) participated in the study. A connected pen was preferred in 79.6% of DCE choices. Preferences were most affected by glucose monitoring options (total: RAI = 41.4%; US: RAI = 43.6%; UK: RAI = 38.4%), followed by additional features (total: RAI = 21.1%; US: RAI = 19.0%; UK: RAI = 24.2%), data sharing functions (total: RAI = 19.6%; US: RAI = 20.4%; UK: RAI = 18.4%), dosing support services (total: RAI = 13.5%; US: RAI = 14.0%; UK: RAI = 12.8%), and device type (total: RAI = 4.3%; US: RAI = 3.0%; UK: RAI = 6.2%). A connected pen was preferred over a standard pen in 4812 out of 6048 scenarios (US:2982/3744; UK:1830/2304). Findings suggest that PwD expect connected insulin pens will be a valuable tool for insulin therapy.

To assess clinical and resource utilization outcomes between elderly type 2 diabetes patients initiating basal insulin analog administered via pens vs. vials. An online survey of 352 U.S. primary care physicians was used to collect retrospective patient chart data on 500 elderly type 2 diabetes patients who initiated on basal insulin analog in 2009. Information on glycemic control, severe hypoglycemic events, and diabetes-related health care resource utilization was collected prior to initiation and over a 12-month study period following insulin initiation. Information on adherence, both objective (measured via proportion of days covered [PDC]) and physician-revised (based on a revision of the objective PDC) was also collected for the study period. Multivariate regression analyses were used to control for confounding factors. Over the study period, initiation on pens, compared to vials, was associated with HbA1c levels 0.14 points lower (P=0.027). No differences were seen in the likelihood of reaching an HbA1c thresholds of 7% (hazard ratio [HR]=1.05, P=0.738), though the likelihood was 27% and 55% higher for pen initiators for HbA1c thresholds of 7.5% (HR=1.27, P=0.041) and 8% (HR=1.55, P<0.001), respectively. Rates of severe hypoglycemic events, inpatient, outpatient, and endocrinologist visits were similar between cohorts, but rates of emergency room visits were 68% lower for the pen cohort (IRR=0.32, P=0.017). No significant differences in objective adherence rates (PDC) were observed (P=0.080), while physician-revised adherence levels indicated a 2.2 percentage point higher adherence level for the pen cohort (P=0.034). Results from this study suggest that initiation on insulin pens, as compared to vials, may be associated with better glycemic control, fewer emergency room visits, and higher adherence levels (based on physician assessments) without an impact to the incidence of severe hypoglycemic events. Objective adherence and other resource utilization categories were not significantly different between the two cohorts.

To evaluate the utilization of and factors associated with HbA1c testing in the inpatient setting among patients with hyperglycemia. Data were obtained from Humedica's Integrated Delivery Networks from October 1, 2009 through September 30, 2011. The analyses focused on hospitalization episodes (admissions and observations) among pre-diabetic/undiagnosed and diabetic patients with blood glucose values ≥140 mg/dl, and are descriptive in nature. Results are statistically significant at the p<0.05 level unless otherwise noted. A total of 55,614 patients contributed to 94,638 unique hospitalization episodes with at least one occurrence of hyperglycemia. HbA1c tests were performed in 24.6% of these hospitalizations, and in 26.4% of patients. Among all hospitalizations, not having an HbA1c test in the previous 3 months was associated with twice the rate of those with a previous test (32.4% vs 16.2%), and hospitalizations with glucose values of 200 mg/dl or greater had a higher rate (27.7%) than did those with lower glucose levels (18.3%). Endocrinologist treatment during a hospitalization was associated with a higher HbA1c utilization rate (43.6%) compared to treatment from all other specialties (23.3%), including hospital medicine (21.1%). Among all patients, younger patients had a higher HbA1c utilization rate than did patients >=65 years (47.2% <21, 29.5% 21-64, and 23.8% 65+), as did male patients (28.3% vs 24.5%). Type 1 diabetics had a higher rate than did patients with pre-diabetes/undiagnosed diabetes and type 2 diabetes (32.0%, 28.7%, and 25.4%, respectively). Among hospitalizations of pre-diabetes/undiagnosed patients who received an HbA1c test, 17.9% had values of 6.5% or greater. These data suggest that overall utilization of HbA1c tests in the hospital setting is low among pre-diabetic/undiagnosed and diabetic patients with hyperglycemia. The utilization rate differs significantly by patient characteristics and by physician specialty. These data highlight the potential to improve identification and diagnosis of diabetes within the hospital setting.

To assess physician beliefs on the relative benefits of pens vs. vials, prescribing drivers, and characteristics of patients newly initiated on basal insulin analog via pens vs. vials among elderly type 2 diabetes patients. An online survey of 352 U.S. primary care physicians was used to collect retrospective patient chart data on 500 elderly type 2 diabetes patients who initiated on basal insulin analog in 2009. For each physician, patient chart selection was randomized among eligible patients. Data on physician characteristics, physicians' opinion on the impact of different routes of administration (ROA), main drivers for selecting a particular ROA for each patient, and patient characteristics were collected. The majority of physician respondents were part of a group practice (77.8%) and treated a mean of 235.5 (SD=185.0) type 2 patients ≥ 65 years old in 2009. Patient characteristics were similar in terms of age and diabetes duration. However, significantly more Caucasians (p = 0.011) and patients covered by Medicare only (p=0.015) were initiated on pens, whereas significantly more women (p=0.003), Black/African Americans (p=0.011), and dual eligible patients (Medicare + Medicaid; p=0.008) were initiated on vials. Patients initiated on vials had higher median baseline HbA1c values (8.7 vs. 8.4, p<0.001).Survey findings suggested that physicians prescribed vials primarily due to patients' economic constraints (62.9% of vial users vs. only 2.4% for pen users), although a majority of physicians considered pens better than vials (89.2% in terms of adherence, 65.1% in terms of HbA1c control, and 55.4% in terms of resource utilization). Results from this retrospective chart extraction survey suggest that patient characteristics differed between patients initiated on pens vs. vials, and that despite insulin pens being perceived as having better outcomes by physicians, economic considerations play a dominant role in the choice of insulin vials.