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

Background The national guideline for diabetes mellitus 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 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 could independently select their injector and were asked immediately afterwards about the criteria for their selection. The process lasted 3 minutes approximately.

Results 349 consecutive patients (94% diabetes type 2; age 58.6 ± 13.4 years; HbA1c 10.4 ± 2.1%) were included. Injector A was selected by 10.0%, B by 61.9% and C by 28.1% of patients. 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 was not associated with age, diabetes type, diabetes duration, BMI, HbA1c, concomitant diseases, diabetes-related complications or the physician/diabetes educator.

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

Publication History

Article published online:
06 May 2021