Introduction & Objective: Once-weekly insulin has the potential to increase willingness to initiate and adhere to insulin therapies in people with type 2 diabetes requiring basal-only insulin therapy. However, the role of once-weekly insulin in people already treated with basal-bolus multiple daily injection regimens, such as people with type 1 diabetes (PwT1D), is less understood. This study aimed to quantify the preferences of PwT1D for novel long-acting insulins.
Methods: A discrete choice experiment survey was administered to PwT1D in the United States. The survey included 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 (TIR), 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: The survey was completed by 200 PwT1D (mean: age = 41 years; A1c = 7.6%; 57% female). They were on a basal (100%), mealtime bolus (98%), or intermediate or premixed insulin (2%). Across attributes, respondents ranked achieving the longest TIR as the most important change, followed by equal importance on the largest change in the number of serious low blood sugar events per month, avoiding a 10 pound weight change, the largest change in the number of nighttime low blood sugar events per month, and weekly over daily basal administration. The largest reduction in HbA1c was the least important attribute in respondents’ decisions. In the fixed-choice question, 73% of people preferred flexible weekly over daily dosing for basal insulin.
Conclusion: The most important attributes were changes in TIR and number of serious hypoglycemic events. PwT1D preferred weekly over daily basal insulin when all other attributes were equal.
D. Schapiro: Employee; Eli Lilly and Company. M. Perez-Nieves: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. C.M. Vass: Other Relationship; Eli Lilly and Company. Consultant; National Institute for Health and Care Excellence (NICE). J. Poon: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. F. Gelsey: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. A. Pierce: None. C. Mansfield: None.
