INTRODUCTION AND OBJECTIVE: For people with type 2 diabetes (T2D), daily insulin regimens can be burdensome, difficult to adhere to, and a key barrier to initiating insulin therapy. Despite developments in once-weekly, long-acting (basal) insulins, little is known about their preferences for administration frequency or its importance relative to other insulin features.
METHODS: An online discrete choice experiment survey was administered to adults with T2D 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, number of serious low blood sugar events, number of nighttime low blood sugar events, 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: A total of 466 people (mean: age = 57; A1c = 7.5; 59% female) completed the survey. They were on a basal/bolus (33.3%), basal-only (34.3%), or insulin-naïve (32.4%) regimen. Relative to other attributes, people placed most importance on avoiding a 10-pound weight change, followed by the largest changes in the number of serious and nighttime low blood sugar events and achieving the longest time in range. There was significant heterogeneity in preference: insulin-naïve respondents strongly preferred weekly administration, whether on the same day each week or a flexible weekly schedule, over daily (p < 0.05). In the fixed-choice question, most (67.6%) preferred flexible weekly over daily dosing.
CONCLUSION: On average, respondents valued insulin efficacy and reducing treatment-related risks, with heterogeneity in the relative importance of administration frequency. All else equal, they preferred weekly over daily basal insulin. The dosing flexibility could be crucial for the insulin naïve.
