Increased Time in Range and Fewer Missed Bolus Injections After Introduction of a Smart Connected Insulin Pen

Abstract

<b><i>Background:</i></b> This observational study investigated whether the connected NovoPen^® 6 could influence insulin regimen management and glycemic control in people with type 1 diabetes (T1D) using a basal-bolus insulin regimen and continuous glucose monitoring in a real-world setting. <b><i>Methods:</i></b> Participants from 12 Swedish diabetes clinics downloaded pen data at each visit (final cohort: <i>n</i> = 94). Outcomes included time in range (TIR; sensor glucose 3.9-10.0 mmol/L), time in hyperglycemia (>10 mmol/L), and hypoglycemia (L1: 3.0- <3.9 mmol/L; L2: <3.0 mmol/L). Missed bolus dose (MBD) injections were meals without bolus injection within -15 and +60 min from the start of a meal. Outcomes were compared between the baseline and follow-up periods (≥5 health care professional visits). Data were analyzed from the first 14 days following each visit. For the TIR and total insulin dose analyses (<i>n</i> = 94), a linear mixed model was used, and for the MBD analysis (<i>n</i> = 81), a mixed Poisson model was used. <b><i>Results:</i></b> TIR significantly increased (+1.9 [0.8; 3.0]_{95% CI} h/day; <i>P</i> < 0.001) from baseline to follow-up period, with a corresponding reduction in time in hyperglycemia (-1.8 [-3.0; -0.6]_{95% CI} h/day; <i>P</i> = 0.003) and L2 hypoglycemia (-0.3 [-0.6; -0.1]_{95% CI} h/day; <i>P</i> = 0.005), and no change in time in L1 hypoglycemia. MBD injections decreased by 43% over the study (<i>P</i> = 0.002). Change in MBD injections corresponded to a decrease from 25% to 14% based on the assumption that participants had three main meals per day. <b><i>Conclusions:</i></b> Our study highlights the potential benefit on glycemic control and dosing behavior when reliable insulin dose data from a connected pen contribute to insulin management in people with T1D.