Choosing an insulin injector by a structured, pharmaceutical-neutral curriculum via an informed shared decision-making process in 349 insulin-naive patients with diabetes mellitus.

BACKGROUND

The national guideline for diabetes type 2 claims to involve patients in their decision-making on therapy. Unfortunately, no structured, pharmaceutical-neutral curriculum is available to guide patients in this shared decision-making (SDM) process regarding the insulin injector. The aim of the study was to evaluate which injector patients chose after SDM process and the reasons for their choice.

METHODS

We developed a curriculum for a SDM process to choose an insulin injector for insulin-naive patients with diabetes mellitus, which took place immediately before the start of the initial treatment with insulin. It was conducted by a physician or diabetes educator with no conflicts of interest. All available human short-acting disposable insulin injectors (A, B and C) were handed out for try-out accompanied by individual counselling. The patients selected their injector of choice and were asked immediately afterwards about the criteria for their selection.

RESULTS

349 consecutive patients (94% diabetes type 2; age 58.6 + 13.4y; HbA1c 10.4 + 2.1%) were included. Patients choose Injector A in 10.0%, B in 61.9% and C in 28.1%. Criteria for selection were: design (41.8%), general impression (23.5%), dose window (7.7%), dose selection dial (7.4%), most practical (6.6%) and other (13%). Selection of a specific injector was not associated with age, diabetes type, diabetes duration, BMI, HbA1c, presence of concomitant diseases, retinopathy, neuropathy, diabetic foot or physician/diabetes educator.

DISCUSSION: Insulin-naive patients with diabetes mellitus chose their own insulin injector within a newly developed structured SDM process to meet the national guideline. Main selection criteria were design and practicability.