title: Understanding bolus insulin dose timing: the characteristics and experiences of people with diabetes who take bolus insulin.
abstract: Despite the increased popularity of newer, fast-acting bolus insulin treatment options that allow for more flexibility in the timing of bolus insulin dosing in recent years, relatively little is known about people with diabetes who administer bolus insulin at differing times in relation to their meals. The purpose of this study was to investigate bolus insulin dose timing in relation to meals among people with type 1 (T1D) and type 2 (T2D) diabetes, as well as to better understand the characteristics and experiences of people who bolus dose at differing times.
  
  
  
  A web-based survey of adults with T1D and T2D treated with bolus insulin therapy in Germany, the UK, and USA was conducted.
  
  
  
  A total of 906 respondents completed the survey (39% T1D; 61% T2D). A majority of respondents reported bolus dosing before meals in the previous week (57.0%), followed by after meals (18.9%), with meals (12.7%), and at varying times (11.5%). Compared to respondents who dosed with or after meals, those who dosed before meals were significantly less likely to experience hypoglycemia (before, 55.7%; with, 72.8%; after, 68.7%; p < .001) in the previous week. Respondents who bolus dosed before meals were significantly more likely to perceive bolus dose timing as flexible (45.5%) compared to those who dosed with (27.8%) or after (35.7%) meals (p < .001).
  
  
  
  Results show that many people with T1D and T2D dose their bolus insulin with or after meals. Key limitations of all self-report surveys include potential bias in responses and generalizability of findings. However, the study was designed to help mitigate these limitations. The findings have implications for clinicians and suggest opportunities for improving diabetes education and care.
authors.affiliation: a Department of Pediatrics , Yale School of Medicine , New Haven , CT , USA.
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
authors.affiliation: b The Brod Group , Mill Valley , CA , USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Pfeiffer
authors.affiliation: b The Brod Group , Mill Valley , CA , USA.
authors.forename: Meryl
authors.initials: M
authors.lastname: Brod
authors.affiliation: c Novo Nordisk, A/S , Søborg , Denmark.
authors.forename: Annie
authors.initials: A
authors.lastname: Nikolajsen
authors.affiliation: c Novo Nordisk, A/S , Søborg , Denmark.
authors.forename: Anna
authors.initials: A
authors.lastname: Sandberg
authors.affiliation: d Keck School of Medicine of the University of Southern California , Los Angeles , CA , USA.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: a Department of Pediatrics , Yale School of Medicine , New Haven , CT , USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Van Name
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Bolus insulin; diabetes management; diabetes mellitus, type 1; diabetes mellitus, type 2; rapid-acting insulin; self-care