Sociodemographic Characteristics of PwD and HCPs

From all patients included in the web-based survey study (N = 1150 PwD), we reported on the German population of 400 PwD (T1D: 25.0%, n = 100; T2D: 75.0%, n = 300) (Table 1). The mean ± SD age of PwD was 47.1 ± 13.0 years; 69.5% were male and 30.5% were female. The majority of PwD were married (78.0%), worked full time (71.3%), and had a bachelor’s degree (32.8%) or an associate degree/professional certification (28.3%). Most PwD were diagnosed between 1 and 5 years ago (37.8%), with 39.3% of PwD reporting use of an insulin pen for more than 2 years.

Table 1 Characteristics of PwD and HCPs

Of the total 640 HCPs participating in the global survey, 160 HCPs (GPs, n = 80; specialists, n = 80) were recruited in Germany; 73.1% of HCPs were male and 26.9% were female, 98.1% were qualified to practice for > 5 years, and 89.4% provided care for more than 10 PwD who followed a weekly insulin pen regimen.

Proportion of PwD Reporting Missed, Mistimed, or Miscalculated Basal and Bolus Insulin Doses and Average Number of Missed and Mistimed Doses in the Last 30 Days

Among PwD who used basal and bolus insulin, 47.3% and 58.0% reported missing basal and bolus insulin doses, respectively, in the past 30 days. This corresponded to a missed mean ± SD of 3.5 ± 2.9 basal and 5.0 ± 10.1 bolus insulin doses (Fig. 1). Overall, 47.3% and 51.0% of PwD reported mistiming basal and bolus insulin doses, respectively, in the past 30 days. This corresponded to a mean ± SD of 3.9 ± 4.3 basal and 5.0 ± 7.1 bolus insulin doses. Overall, 47.5% and 63.3% of PwD reported taking too little (miscalculating) basal and bolus insulin doses, respectively, in the past 30 days. This corresponded to a mean ± SD of 4.5 ± 5.0 basal and 5.5 ± 7.5 bolus insulin doses.

Fig. 1

Proportion of PwD reporting missed/skipped, mistimed, or miscalculated insulin doses and average number of missed, mistimed, or miscalculated doses in the last 30 days. A total of 400 PwD received basal insulin, of whom 300 PwD received bolus: people with T2D receiving basal insulin only (n = 100); PwD receiving basal and bolus insulin (T1D, n = 100; T2D, n = 200). PwD people with diabetes, SD standard deviation, T1D type 1 diabetes, T2D type 2 diabetes

Percentage of HCPs Estimating the Proportion of PwD who Missed/Forgot/Skipped, Mistimed, or Miscalculated Insulin Doses in the Last 30 Days

HCPs (≥ 67%) indicated that up to 30% of PwD missed/forgot/skipped, mistimed, or miscalculated an insulin dose (Fig. 2). Specifically, 71.9% and 75.0% indicated that up to 30% of PwT2D missed bolus and basal insulin doses, respectively. Overall, 75.6% of HCPs indicated that up to 30% of PwT1D mistimed bolus insulin doses, with 18.8% of HCPs indicating that 31–70% of PwT2D mistimed bolus insulin doses. More than 68% of HCPs indicated that up to 30% of PwT1D and PwT2D miscalculated bolus and basal insulin doses (bolus: 70.0% vs 68.1%, respectively; basal: 61.31% vs 69.4%, respectively). Overall, 23.1% of HCPs indicated that 31–70% of PwT2D miscalculated bolus insulin doses.

Fig. 2

Percentage of HCPs estimating the proportion of PwD who missed/forgot/skipped, mistimed, or miscalculated insulin doses in the last 30 days. 1–30%, 31–70%, and ≥ 71% are collapsed categories. Numbers represent percentages. HCP healthcare professional, PwD people with diabetes, T1D type 1 diabetes, T2D type 2 diabetes

Reasons Reported by PwD and HCPs for Missing, Mistiming, or Miscalculating Bolus and Basal Insulin Doses in the Last 30 Days

The most frequent reasons reported by PwD for missing basal/bolus insulin doses included forgetting (basal, 32.3%; bolus, 26.4%), finding it acceptable to miss a dose sometimes (basal, 31.2%; bolus, 17.8%), needing a break from figuring out/taking a dose (basal, 29.6%; bolus, 19.0%), being too busy and/or distracted (basal, 23.8%; bolus, 28.7%), and finding it too complicated and burdensome (basal, 23.3%; bolus, 23.6%; Table 2). The most frequent reasons reported by PwD for mistiming basal/bolus insulin doses included being too busy and/or distracted (basal, 29.1%; bolus, 35.3%), finding it too complicated and burdensome (basal, 28.6%; bolus, 20.3%), and not being sure of how much insulin to take (basal, 24.9%; bolus, 26.1%). For miscalculated basal/bolus insulin doses, reasons included not being sure how much insulin to take (basal, 42.6%; bolus, 38.9%), not measuring blood sugar (basal, 29.5%; bolus, 31.6%) or not wanting to take a dose in front of others (basal, 29.5%; bolus, 21.1%), and wanting to prevent excessive lowering of blood sugar levels (basal, 26.3%; bolus, 28.9%). Differences were seen in the reasons identified by HCPs for PwD missing, mistiming, and miscalculating a basal/bolus insulin dose. For missed basal/bolus insulin doses, HCPs reported that PwD forgot (basal, 74.4%; bolus, 79.4%), were too busy or distracted (basal, 47.5%; bolus, 56.9%), were out of their normal routine (basal, 45.0%; bolus, 57.5%), or wanted to prevent excessive lowering of their blood sugar levels (basal, 43.1%; bolus, 46.9%). Concerning mistimed basal/bolus insulin, HCPs felt that PwD forgot (basal, 56.3%; bolus, 43.8%), were too busy or distracted (basal, 53.8%; bolus, 58.8%), or were out of their normal routine (basal, 51.3%; bolus, 51.9%).

Table 2 Reasons PwD and HCPs reported missing, mistiming, or miscalculating bolus and basal insulin doses in the last 30 days

Regarding miscalculated basal/bolus insulin doses, reasons perceived by HCP included PwD being out of their normal routine (basal, 45.0%; bolus, 41.3%), not being sure of how much insulin to take (basal, 44.4%; bolus, 58.1%), not measuring their blood sugar levels (basal, 40.0%; bolus, 54.4%), finding it too complicated or burdensome (basal, 30.6%; bolus, 45.6%), or wanting to prevent excessive lowering of their blood sugar levels (basal, 34.4%; bolus, 47.5%).

Solutions Reported by PwD and HCPs for Optimising Insulin Dosing

The most frequent solution to optimise insulin dosing reported by PwD was having a device that automatically records glucose measurements (69.3%) and insulin doses and timing (67.3%), as well as having real-time insulin dosing calculation guidance (66.5%) and real-time feedback on how insulin dosing impacts glucose levels (68.5%; Fig. 3). PwD also reported having meaningful conversations with HCPs about insulin dosing routine (64.0%) and dosing reminders in a mobile application (62.8%) as solutions.

Fig. 3

PwD and HCP solutions for optimising insulin dosing (%). HCP healthcare professional, PwD people with diabetes. Numbers represent percentages

HCPs indicated that having a device that automatically records glucose measurements (79.4%) or insulin doses and timing (76.3%) and having real-time insulin dosing calculation guidance (71.3%) and real-time feedback on how insulin dosing impacts glucose levels (70.0%) would be very helpful for PwD to optimise their insulin dosing.