title: Dosing irregularities and self-treated hypoglycemia in type 2 diabetes: results from the Canadian Cohort of an International Survey of Patients and Healthcare Professionals.
abstract: OBJECTIVE
  Despite their importance in achieving good glycemic control, few real-world data on insulin dosing irregularities and hypoglycemia are available. The multinational, online Global Attitude of Patients and Physicians (GAPP2) survey was conducted to address this situation.
  
  
  METHODS
  Insulin-treated patients with type 2 diabetes and healthcare professionals (HCPs) who treat such patients were surveyed in an online cross-sectional study. This article summarizes findings from a sample of the online population in a Canadian cohort of 156 patients and 202 HCPs.
  
  
  RESULTS
  A total of 156 patients completed the questionnaires; 26% reported experiencing a dosing irregularity (missed, mistimed or reduced a basal insulin dose) in the previous 30 days. Up to 60% reported risk for hypoglycemia as the reason for intentional dosing irregularities. Of all patients, 80% reported experiencing a self-treated hypoglycemic event, and 33% recalled having at least 1 event in the previous month. HCPs recorded similar levels of patient-reported dosing irregularities. Over 90% indicated they recommended patients to temporarily reduce their insulin doses to deal with hypoglycemia.
  
  
  CONCLUSIONS
  A sizeable minority of patients experienced dosing irregularities and self-treated hypoglycemia in this Canadian cohort. The data suggest that HCPs who completed the survey are aware of this and of the need to provide education and support for patients who regularly miss, mistime or reduce insulin doses. Although the desire to prevent hypoglycemic events is understandable and important, HCPs need to ensure fear of hypoglycemia does not compromise optimal diabetes management.
authors.affiliation: Division of Endocrinology and Metabolism, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada, and Departments of Medicine and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada. Electronic address: leiterl@smh.ca.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.affiliation: Novo Nordisk Canada, Mississauga, Ontario, Canada.
authors.forename: Damir
authors.initials: D
authors.lastname: Boras
authors.affiliation: Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Woo
keywords: autotraitement de l'hypoglycémie; diabète de type 2; dose d'insuline basale oubliée; misdosing of basal insulin; self-treated hypoglycemia; type 2 diabetes