INTRODUCTION AND OBJECTIVE: It is hypothesized that once-weekly insulin will have the potential to increase willingness to initiate and adhere to insulin therapies in people with type 2 diabetes requiring basal-only insulin therapy. However, the role of and need for once-weekly insulin in people already treated with basal-bolus multiple daily injection regimens, such as people with type 1 diabetes (PwT1D), is less understood. This study used preference surveys to quantify the preferences of PwT1D for novel long-acting insulin treatments.
METHODS: An online discrete choice experiment survey was administered to adults with T1D in the United States. Each respondent completed 8 questions offering a choice between experimentally designed pairs of hypothetical, long-acting insulins that varied by 6 attributes: reduction in A1c level after 6 months, daily time in range (TIR), number of serious blood sugar events per month, number of nighttime low blood sugar events per month, weight change over 6 months, and administration frequency. A fixed choice question directly elicited preferences for flexible weekly over daily insulin, holding all other attributes equal. Data were analyzed with random-parameter logits.
RESULTS: 200 PwT1D (mean: age = 41 years; A1c = 7.6%; 57% female) completed the survey. Respondents’ treatment regimens included basal (100%), mealtime bolus (98%), or intermediate or premixed insulin (1.5%). Respondents ranked the following attributes in order of most importance: achieving the longest TIR, the change in the number of serious low blood sugar events per month, avoiding a 10-pound weight change, the change in the number of nighttime low blood sugar events per month, basal administration frequency, and reduction in HbA1c. In the fixed-choice question, 67.6% of people preferred flexible weekly over daily basal insulin.
CONCLUSION: Overall, PwT1D valued insulin efficacy and reducing treatment-related risks. All else equal, PwT1D preferred weekly over daily basal insulin.
