Nonadherence to insulin therapy detected by Bluetooth-enabled pen cap is associated with poor glycemic control

Abstract

Objective: To objectively evaluate adherence to timing and dosing of insulin by using Bluetooth pen caps and examine factors related to adherence. Research Design and Methods: Bluetooth-enabled insulin pen caps were used in younger (ages 18-35 years) and older (ages ≥65 years) adults on two or more insulin injections per day. Results: We evaluated 75 participants with diabetes, 42 younger (29 ± 4 years) and 33 older (73 ± 7 years). Nonadherence was found in 24% of bolus (Apidra) doses and 36% of basal (Lantus) doses. We divided participants into tertiles on the basis of overall adherence, with the most adherent tertile having 85% dose adherence compared with 49% in the least adherent tertile (P < 0.001). Participants in the most adherent tertile had better glycemic control than those in the least adherent tertile (7.7 ± 1.1% [61 ± 12 mmol/mol] vs. 8.6 ± 1.5% [70 ± 16.4mmol/mol], P < 0.03). Conclusions: Nonadherence to insulin dosing and timing can be objectively assessed by Bluetooth pen caps and is associated with poor glycemic control.