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Impact of telephonic interviews on persistence and daily adherence to insulin treatment in insulin-naïve type 2 diabetes patients: dropout study

Authors Yavuz DG, Bilen H, Sancak S, Garip T, Hekimsoy Z, Sahin I, Yilmaz M, Aydin H, Atmaca A, Sert M, Karakaya P, Arpaci D, Oguz A, Guvener N

Received 16 November 2015

Accepted for publication 17 March 2016

Published 17 May 2016 Volume 2016:10 Pages 851—861

DOI https://doi.org/10.2147/PPA.S100626

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Dilek Gogas Yavuz,1 Habip Bilen,2 Seda Sancak,3 Tayfun Garip,4 Zeliha Hekimsoy,5 Ibrahim Sahin,6 Murat Yilmaz,7 Hasan Aydin,8 Aysegul Atmaca,9 Murat Sert,10 Pinar Karakaya,11 Dilek Arpaci,4 Aytekin Oguz,12 Nilgun Guvener13

On behalf of the Dropout Study Group

1Department of Endocrinology and Metabolism, Marmara University Faculty of Medicine, Istanbul, 2Department of Endocrinology and Metabolism, Ataturk University Faculty of Medicine, Erzurum, 3Clinic of Endocrinology and Metabolism, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, 4Clinic of Endocrinology and Metabolism, Sakarya State Hospital, Sakarya, 5Department of Endocrinology and Metabolism, Celal Bayar University Faculty of Medicine, Manisa, 6Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine, Malatya, 7Department of Endocrinology and Metabolism, Namik Kemal University Faculty of Medicine, Tekirdag, 8Department of Endocrinology and Metabolism, Yeditepe University Faculty of Medicine, Istanbul, 9Department of Endocrinology and Metabolism, Ondokuzmayis University Faculty of Medicine, Samsun, 10Department of Endocrinology and Metabolism, Cukurova University Faculty of Medicine, Adana, 11Clinic of Endocrinology and Metabolism, Bakirkoy Training and Research Hospital, Istanbul, 12Department of Internal Medicine, Medeniyet University Faculty of Medicine, Istanbul, 13Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Istanbul, Turkey

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.
Conclusion: 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.

Keywords: type 2 diabetes, insulin analogs, HbA1c, self-monitoring of blood glucose

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