title: Behaviours, thoughts and perceptions around mealtime insulin usage and wastage among people with type 1 and type 2 diabetes mellitus: A cross-sectional survey study.
abstract: OBJECTIVE
  People with diabetes who use mealtime insulin (MTI) were surveyed about insulin wastage and injection habits when insufficient insulin remains in a disposable prefilled pen/cartridge to administer a full dose in a single injection.
  
  
  METHODS
  Cross-sectional, online, self-reported survey of MTI usage/wastage behaviour in 400 adults with type 1 (n=120) or type 2 (n=280) diabetes mellitus administering >20units/day of MTI via 100units/ml prefilled pens/cartridges for ⩾1month, conducted in France, Germany, Italy and UK.
  
  
  RESULTS
  Participants' mean±standard deviation age was 54.5±12.2years, body mass index was 29.9±7.2kg/m2and duration of MTI therapy was 8.6±7.8years. They administered 3.7±5.9 injections/day with meals, using 11.3±18.0 prefilled pens/cartridges per month. Overall, 63.5% split the dose across two prefilled pens/cartridges (i.e. administered two injections to obtain a full dose), 15.0% used just what remained in their current pen (i.e. took a lower-than-prescribed dose) and 36.3% discarded prefilled pens/cartridges still containing insulin (i.e. took full dose with new pen). The latter participants discarded a mean 5.5±8.2 prefilled pens/cartridges monthly still containing insulin, each containing 8.6±8.7 units of insulin. Participants who wasted insulin considered it frustrating, time-consuming and painful to inject twice.
  
  
  CONCLUSIONS
  Patients taking >20units/day MTI can find transitions between insulin pens challenging. This study highlights the need to identify ways of improving transitions between pens to make transitions easier for insulin users, which could potentially improve adherence to prescribed doses and reduce waste.
authors.affiliation: Eli Lilly & Company Ltd, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH, UK. Electronic address: van_brunt_kate@lilly.com.
authors.forename: Kate
authors.initials: K
authors.lastname: Van Brunt
authors.affiliation: Kantar Health, The Kirkgate, 19-31 Church Street, Epsom, Surrey KT17 4PF, UK; RTI Health Solutions, Travessera de Gracia 56, Ático 1(a), 08006 Barcelona, Spain. Electronic address: riccardo.pedersini@gmail.com.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pedersini
authors.affiliation: Kantar Health, 11 Madison Avenue 12th Floor, New York, NY 10010, USA. Electronic address: Jillian.Rooney@kantarhealth.com.
authors.forename: Jillian
authors.initials: J
authors.lastname: Rooney
authors.affiliation: Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. Electronic address: corrigan_sheila_m@lilly.com.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Corrigan
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005602:France; D005858:Germany; D015438:Health Behavior; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D007558:Italy; D008297:Male; D062407:Meals / Q000523:psychology; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010465:Perception; D011795:Surveys and Questionnaires; D013850:Thinking; D006113:United Kingdom; D016903:Drug Monitoring
chemical_list: D007328:Insulin
keywords: Mealtime insulin; Patient-reported outcomes; Rapid-acting insulin; Type 1 diabetes; Type 2 diabetes; Wastage