Abstract 21: The burden of mealtime insulin dosing in adults and children with type 1 diabetes

Background and Aims: Timely and accurate mealtime insulin dosing is an ongoing challenge for people with type 1 diabetes (T1D). This multinational study aimed to assess attitudes, behaviours and the overall impact of pre-meal (15-20 minutes) bolus insulin dosing from the perspective of adults with T1D, parents of children with T1D and physicians. Materials and Methods: Online surveys were conducted in 2711 participants (recruited from an online panel) who chose to take part across USA, Canada, UK, Japan, Spain and France between 25 Nov 2019 and 06 Feb 2020. Participants were 1401 adults aged ≥18 with T1D, 350 parents who live with children with T1D aged ≤15 years and 960 physicians who have practised for 4-40 years. Adults/children had T1D for ≥6 months and were taking a bolus insulin (excluding fast-acting insulinaspart). Physicians were responsible for starting or managing treatment for T1D and the prescription of mealtime insulin. This analysis provides a country average assuming equal sizes for each country, to give an overall indication of results across the six countries in the study. Results: Of the surveyed adults with T1D (46% male; mean age was 43 years; mean of 19 years with T1D), 72% administered their bolus insulin by injection and 28% used an insulin pump. Continuous glucose monitoring (CGM) was used by 43% of adults. Of the parents surveyed (64% male; mean age was 10 years; mean of 4 years with T1D), 74% administered their bolus insulin by injection and 26% used an insulin pump, with 58% using CGM. The findings indicate that a majority (96%) of both adults with T1D and parents of children with T1D understood the importance of administering bolus insulin accurately. However, few adults (35%) and parents (47%) felt very confident in estimating the amount of insulin required accurately and 91% of adults and 96% of parents experienced challenge(s) with pre-meal insulin dosing. Almost all physicians (99.6%) reported that they believed their patients with T1D faced challenge(s) with pre-meal bolus insulin dosing. Of those surveyed, 25% of adults and 38% of parents forgot to administer pre-meal insulin ≥1 a week, and 70%of adults and 81%of parents reported that they/their child ate more or less than anticipated following their mealtime insulin ≥1 aweek. Accordingly, 68% of adults and 79% of parents indicated that they/their child needed to take corrective action ≥1 a week by either eating more or taking more insulin. A majority of participants (82% of adults, 93% of parents) felt that administering insulin 15-20 minutes before a meal had a negative impact on their/their child's day-to-day life; 91% of physicians concurred that this creates an extra burden in the day-to-day lives of people with T1D. When asked their preference, 73%of adults and 67% of parents preferred bolus insulin administration either immediately before (42% adults, 44% parents) or after (31% adults, 23% parents) a meal. A high proportion of adults with T1D (67%) and parents (72%) claimed that taking bolus insulin immediately before or after a meal would have a positive impact on their overall quality of life. Conclusion: Based on the study findings, although the importance of accurate mealtime dosing was well recognized, bolus insulin dosing still poses clear challenges to most people with T1D. Given the choice, the majority of participants would prefer to administer insulin immediately prior to or following a meal, as this was perceived to improve quality of life.