A survey of 855 healthcare providers found gaps in their understanding of how hypoglycemia impacts patient behavior and physician treatment approaches compared to published findings from the GAPP study. Only 30% of providers correctly identified how often patients miss insulin doses, and most overestimated this frequency. While fear of hypoglycemia was the top reason for non-adherence in GAPP, providers here most often cited other reasons. Providers also believed physicians were less aggressive in treatment to avoid hypoglycemia less often than reported in GAPP. The results present opportunities for education by field medical teams to increase provider awareness of these challenges patients face.

1. Provider Perceptions Regarding the Impact of Hypoglycemia on Insulin Therapy:
A Field Medical Team Based Survey
D. Noller, B. Fedutes Henderson, R. Lakamp, K. Pendleton, H. Anhalt, M. Kazemi, S. Levesque
Sanofi US, 55 Corporate Drive, Bridgewater, NJ 08807
CONCLUSIONS
For the HCPs that were surveyed, understanding the
impact that hypoglycemia has on patient and physician
behavior was discordant from the findings of the
GAPP study. These data demonstrate the knowledge
gaps that exist among HCPs and provide an
opportunity for education by the field medical team.
Specific to pharmacists, increasing awareness related
to hypoglycemia and non-adherence to insulin therapy
may help improve their management of patients with
diabetes. Discussion of results from this survey
provides a novel field medical approach to increase
HCP awareness of patient and provider perceptions of
hypoglycemia and the challenges patients confront on
current insulin therapies.
BACKGROUND
Despite improvements in insulin therapy, patients are reluctant to
inject themselves at least in part due to fear of hypoglycemia.
Providers cite this as a reason to delay initiation or intensify
therapy. A proactive, educational survey for Healthcare providers
(HCPs) to assess their understanding of patient behavior and
their own perceptions was derived from the Global Attitudes of
Physicians and Patients (GAPPTM) study. The GAPP study was
designed to evaluate patient and physician opinions regarding
insulin therapy.1-2 The HCP responses to the survey were
compared to the published results in the GAPP study.
OVERALL RESULTS
METHODS
Surveys were conducted by a Sanofi Diabetes Regional Medical
Liaison (RML) during face-to-face interactions with HCPs utilizing
Survey Monkey® via an iPad. The following 6 questions were
asked in a multiple choice fashion.
Q1: How many days on average in the last month do patients with
diabetes on insulin therapy report either missing their insulin dose or not
taking it exactly as prescribed (non-adherence)? Answers: 2, 3, 5 or 7
days
Q2: Which of the following factors has a greater correlation with patient
non-adherence to insulin than the perception that injections are painful?
Answers: Duration of Diabetes, Use of Syringes, Frequency of Self-
Blood Glucose Monitoring or Hypoglycemia Frequency
Q3: What is the approximate percentage of physicians who report that
concern regarding hypoglycemia limits the aggressiveness of their
diabetes treatment? Answers: 10%, 30%, 50% or 70%
Q4: What is the approximate percentage of patients with diabetes who
wish that insulin regimens would be flexible to accommodate changes in
their daily lives? Answers: 20%, 40%, 60%, or 80%
Q5: What is your specialty? Answers: Family Practice, Internal Medicine,
Diabetologist, Endocrinologist, Nurse Practitioner, Physician Assistant,
Pharmacist, Nurse or CDE (Certified Diabetes Educator)
Q6: RML Region? Answers: Mid-Atlantic, West, Southeast, Northeast,
Southwest or Central
855 surveys were conducted over a 1 year period (2014). The
majority of responders were: Family Practice physicians, Nurse
Practitioners and Nurses (18%); followed by Internal Medicine
physicians at 14% and Pharmacists at 13%. Responders were
evenly distributed across regions. When asked how frequently
they thought their patients missed or omitted their insulin dose
monthly, only 30% of HCPs provided an answer consistent with
the GAPP study findings (3 days) whereas 45% thought
anywhere between 5-7 days was the appropriate response.
Frequency of SMBG (36%) was the most common response as
to the reason for non-adherence and was not consistent with the
response from the GAPP survey which was fear of
hypoglycemia (31%). When the HCPs were asked about
percentage of physicians who are less aggressive
therapeutically because of hypoglycemia, they answered 30%;
however, the GAPP survey reported as many as 70% of
physicians are less aggressive in order to avoid hypoglycemia.
The majority of HCPs surveyed correctly identified that up to
80% of patients wish insulin regimens would be more flexible to
accommodate changes in their daily lives.
References:
1. Peyrot M, et al.Diabetes Obes Metab.2012:14:1081-87
2. Peyrot M, et al.Diabetic Medicine.2012:29:682-689
13% of the responders of our survey were pharmacists. In general, their
responses were consistent with the GAPP study findings with the
exception of Q2 and Q3. The majority of pharmacists believed use of
syringes and frequency of SMBG to be the most common reason for
non-adherence. Only 22% choose fear of hypoglycemia. Pharmacists
also reported a much lower number of physicians were less aggressive
to avoid hypoglycemia (15%) vs. 70% in the published GAPP survey.
PHARMACY RESULTS