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. 2008 Mar;2(2):229-35.
doi: 10.1177/193229680800200209.

How much do forgotten insulin injections matter to hemoglobin a1c in people with diabetes? A simulation study

Jette Randløv  1 , Jens Ulrik Poulsen
Affiliations

How much do forgotten insulin injections matter to hemoglobin a1c in people with diabetes? A simulation study

Jette Randløv et al. J Diabetes Sci Technol. 2008 Mar.

Abstract

Background: Forgotten or omitted insulin injections are an important contributing factor to poor glycemic control in people with type 1 diabetes. This study uses mathematical modeling and examines the impact on hemoglobin A1c (HbA1c) levels if insulin injections are forgotten. The simulation concerns people with type 1 diabetes on intensive insulin therapy.

Methods: Five sets of blood glucose profiles with and without a forgotten injection were obtained. The difference to HbA1c was calculated using an HbA1c estimator on the profiles and was multiplied by the frequency of forgotten events. A frequency of 2.1 forgotten injections per week was found in the literature.

Results: Calculations showed that forgetting 2.1 meal-related injections per week would lead to an increase in HbA1c of at least 0.3-0.4% points, and similarly 0.2-0.3% points related to forgotten injections of the long-acting insulin. In case of even more pronounced nonadherence (e.g., if 39% of all injections are forgotten) there is a possible increase of HbA1c of 1.8% points.

Conclusions: The magnitude of the possible improvement in HbA1c agrees well with other studies in the relation between adherence and HbA1c levels. The estimated numbers suggest that missing injections are an important reason for suboptimal treatment.

Keywords: HbA1c; adherence; compliance; self-treatment.

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Figures

Figure 1.
Figure 1.
Forgetting breakfast bolus case.
Figure 2.
Figure 2.
Forgetting long-acting insulin in the early afternoon.
Figure 3.
Figure 3.
Blood glucose distribution at each 5-minute interval during meal-induced hyperglycemia test in a DirecNet study where the bolus was intentionally delayed for 1 hour. Reprinted with permission from Weinzimer.
Figure 4.
Figure 4.
Omitting a meal bolus. The red curve is based on data from the DirecNet study.
Figure 5.
Figure 5.
Forgetting lunch insulin. Simulated profiles from AIDA.
Figure 6.
Figure 6.
Forgetting bedtime long-acting insulin. Simulated profiles from AIDA.
Figure 7.
Figure 7.
The relation between plasma glucose and HbA1c based on DCCT covering 26,056 HbA1c values with a 95% confidence interval for the mean for all patients. R = 0.68.
See this image and copyright information in PMC

References

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