Impact of telephonic interviews on persistence and daily adherence to insulin treatment in insulin-naïve type 2 diabetes patients: dropout study.
OBJECTIVE
The objective of this study is to evaluate the impact of sequential telephonic interviews on treatment persistence and daily adherence to insulin injections among insulin-naïve type 2 diabetes patients initiated on different insulin regimens in a 3-month period.


METHODS
A total of 1,456 insulin-naïve patients with type 2 diabetes (mean [standard deviation, SD] age: 56.0 [12.0] years, 49.1% were females) initiated on insulin therapy and consecutively randomized to sequential (n=733) and single (n=723) telephonic interview groups were included. Data on insulin treatment and self-reported blood glucose values were obtained via telephone interview. Logistic regression analysis was performed for factors predicting increased likelihood of persistence and skipping an injection.


RESULTS
Overall, 76.8% patients (83.2% in sequential vs 70.3% in single interview group, (P<0.001) remained on insulin treatment at the third month. Significantly higher rate for skipping doses was noted in basal bolus than in other regimens (27.0% vs 15.0% for premixed and 15.8% basal insulin, respectively, P<0.0001). Logistic regression analysis revealed sequential telephonic interview (odds ratio [OR], 1.531; 95% confidence interval [CI], 1.093-2.143; P=0.013), higher hemoglobin A1c levels (OR, 1.090; 95% CI, 0.999-1.189; P=0.049), and less negative appraisal of insulin therapy as significant predictors of higher persistence. Basal bolus regimen (OR, 1.583; 95% CI, 1.011-2.479; P=0.045) and higher hemoglobin A1c levels (OR, 1.114; 95% CI, 1.028-1.207; P=0.008) were the significant predictors of increased likelihood of skipping an injection.


CONCLUSIONS
Our findings revealed positive influence of sequential telephonic interview, although including no intervention in treatment, on achieving better treatment persistence in type 2 diabetes patients initiating insulin.
Department of Endocrinology and Metabolism, Marmara University Faculty of Medicine, Istanbul, Turkey.
Dilek Gogas
DG
Yavuz
Department of Endocrinology and Metabolism, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Habip
H
Bilen
Clinic of Endocrinology and Metabolism, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
Seda
S
Sancak
Clinic of Endocrinology and Metabolism, Sakarya State Hospital, Sakarya, Turkey.
Tayfun
T
Garip
Department of Endocrinology and Metabolism, Celal Bayar University Faculty of Medicine, Manisa, Turkey.
Zeliha
Z
Hekimsoy
Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine, Malatya, Turkey.
Ibrahim
I
Sahin
Department of Endocrinology and Metabolism, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey.
Murat
M
Yilmaz
Department of Endocrinology and Metabolism, Yeditepe University Faculty of Medicine, Istanbul, Turkey.
Hasan
H
Aydin
Department of Endocrinology and Metabolism, Ondokuzmayıs University Faculty of Medicine, Samsun, Turkey.
Aysegul
A
Atmaca
Department of Endocrinology and Metabolism, Cukurova University Faculty of Medicine, Adana, Turkey.
Murat
M
Sert
Clinic of Endocrinology and Metabolism, Bakırkoy Training and Research Hospital, Istanbul, Turkey.
Pinar
P
Karakaya
Clinic of Endocrinology and Metabolism, Sakarya State Hospital, Sakarya, Turkey.
Dilek
D
Arpaci
Department of Internal Medicine, Medeniyet University Faculty of Medicine, Istanbul, Turkey.
Aytekin
A
Oguz
Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Istanbul, Turkey.
Nilgun
N
Guvener
HbA1c; insulin analogs; self-monitoring of blood glucose; type 2 diabetes