You have Type 1 diabetes and have been taking pre-mixed insulin twice daily, once ... can expect that your dosage will need to be adjusted from time to time.
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Pharmacoeconomics 2008; 26 (3): Supplementary Material
ORIGINAL RESEARCH ARTICLE
1170-7690/08/003-0001/$48.00/0 © 2008 Adis Data Information BV. All rights reserved.
Preferences of Patients with Diabetes Mellitus for Inhaled versus Injectable Insulin Regimens Jeremy Chancellor1, Samuel Aballéa1, Alison Lawrence2, Rob Sheldon2, Sandrine Cure1, Juliette Plun-Favreau3 and Nick Marchant3 1 2 3
i3 Innovus, Uxbridge, Middlesex, UK Accent, Chiswick, London, UK Pfizer Limited, Tadworth, Surrey, UK
Supplementary Material This supplementary material contains the information referred to in the full version of this article, which can be found at http://pharmacoeconomics.adisonline.com
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Clinical scenario 1 • •
You have Type 1 diabetes and have been taking pre-mixed insulin twice daily, once before breakfast and once before your evening meal. With pre-mixed injections, you have to eat once you have taken an injection, to avoid a hypo.
•
Your doctor has told you that your glucose levels are not within the target range. In order to improve control he/she advises you to switch to a new insulin routine.
•
As you have Type 1 diabetes and do not produce any insulin of your own, it is essential that you take your insulin regularly as directed. If you do so, you can expect good glucose control, so the chances of your developing diabetes-related health problems would be reduced. You can expect that your dosage will need to be adjusted from time to time. Treatment scenario 1x
Treatment scenario 1y
•
Based on your doctor’s advice, you have started on a new insulin routine.
•
Based on your doctor’s advice, you have started on a new insulin routine.
•
You take one long-acting injection at the same time each day.
•
You take one long-acting injection at the same time each day.
•
You take a short-acting injection before each meal, usually three times a day.
•
You take short-acting insulin before each meal, usually three times daily, using an inhalation device.
•
So normally you take four injections a day in total.
•
So normally you take one injection and three inhalations a day in total.
•
The diabetes nurse has instructed you on your new insulin routine.
•
The diabetes nurse has instructed you on your new insulin routine and on use and care of the inhaler.
•
You can vary the timing of the short-acting injections according to when you plan to eat, but you must wait approximately 20 minutes after an injection before eating.
•
You can vary the timing of the inhalations according to when you plan to eat, and after inhalations you can eat straight away without waiting.
•
You keep your supply of injectable insulin in the refrigerator.
•
You keep your supply of injectable insulin in the refrigerator. The inhaled insulin does not need to be stored in the refrigerator.
• •
You are monitoring your glucose levels regularly with a fingertip test.
•
You are monitoring your glucose levels regularly with a fingertip test.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control.
3 Clinical scenario 2 •
You have Type 1 diabetes and have been taking one long-acting injection at the same time each day and a short-acting injection before each meal, usually three times a day. • •
So normally you take four injections a day in total.
Your doctor has told you that your glucose levels are not within the target range and is testing your blood pressure and cholesterol.
•
He/she also wants you to monitor your blood glucose more frequently and adjust your insulin dosage as necessary, in order to improve control.
•
It is essential that you take your insulin regularly as directed. To help you do this, your doctor is offering you the choice of staying with your injections or using a new type of inhaled insulin in place of your short-acting injections, as you prefer. •
Both treatments are equally effective.
Treatment scenario 2x
Treatment scenario 2y
•
You have decided to stay with your insulin injection routine, which your doctor has reviewed based on test results and your glucose readings.
•
You have decided to switch to a part injection, part inhaled insulin routine, which your doctor has prescribed based on test results and your glucose readings.
•
You take one long-acting injection at the same time each day.
•
You take one long-acting injection at the same time each day.
•
You take a short-acting injection before each meal, usually three times a day.
•
You take short-acting insulin before each meal, usually three times daily, using an inhalation device.
•
So normally you take four injections a day in total.
•
So normally you take one injection and three inhalations a day in total.
•
The diabetes nurse has instructed you on your insulin routine.
•
The diabetes nurse has instructed you on your insulin routine and on use and care of the inhaler.
•
You can vary the timing of the short-acting injections according to when you plan to eat, but you must wait approximately 20 minutes after an injection before eating.
•
You can vary the timing of the inhalations according to when you plan to eat, and after inhalations you can eat straight away without waiting.
•
You keep your supply of injectable insulin in the refrigerator.
•
You keep your supply of injectable insulin in the refrigerator. The inhaled insulin does not need to be stored in the refrigerator.
• •
You are monitoring your glucose levels regularly with a fingertip test.
•
You are monitoring your glucose levels regularly with a fingertip test.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control.
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Clinical scenario 3 •
You have Type 2 diabetes and have been taking pre-mixed insulin twice daily, once before breakfast and once before your evening meal.
•
With pre-mixed injections, you have to eat once you have taken an injection, to avoid a hypo.
•
Your doctor has told you that your glucose levels are not within the target range and in order to improve control he/she advises you to switch to a new insulin routine. •
It is essential that you take your insulin regularly as directed. If you do so, you can expect good glucose control, so the chances of your developing diabetes-related health problems would be reduced. •
You can expect that your dosage will need to be adjusted from time to time.
Treatment scenario 3x
Treatment scenario 3y
•
Based on your doctor’s advice, you have started on a new insulin routine.
•
Based on your doctor’s advice, you have started on a new insulin routine.
•
You take one long-acting injection at the same time each day and a short-acting injection before each meal, usually three times a day.
•
You take one long-acting basal injection at the same time each day. You take short-acting insulin before each meal, usually three times daily, using an inhalation device.
•
So normally you take four injections a day in total.
•
So normally you take one injection and three inhalations a day in total.
•
The diabetes nurse has instructed you on your new insulin routine.
•
The diabetes nurse has instructed you on your new insulin routine and on use and care of the inhaler.
•
You can vary the timing of the short-acting injections according to when you plan to eat, but you must wait approximately 20 minutes after an injection before eating.
•
You can vary the timing of the inhalations according to when you plan to eat, and after inhalations you can eat straight away without waiting.
•
You keep your supply of injectable insulin in the refrigerator.
•
You keep your supply of injectable insulin in the refrigerator. The inhaled insulin does not need to be stored in the refrigerator.
•
• •
You are monitoring your glucose levels regularly with a fingertip test.
•
You are monitoring your glucose levels regularly with a fingertip test.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control
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Clinical scenario 4 •
You have Type 2 diabetes and have been taking several different types of oral treatment.
•
Your doctor has told you that your blood glucose is no longer within the target range, and advises that you need to start taking insulin.
•
Your insulin dosage may need to be adjusted from time to time and your doctor, together with you, will review whether you still need your tablets. •
If you can get used to the daily insulin routine, you can expect good glucose control, so the chances of your developing diabetes-related health problems would be reduced.
Treatment scenario 4x
Treatment scenario 4y
•
Based on your doctor’s advice, you have started on insulin, which you inject once daily with a pen device.
•
Based on your doctor’s advice, you have started on insulin, which you take before meals, up to three times daily, using an inhalation device. You do not need injections.
•
The diabetes nurse has instructed you on using insulin, including injection technique, needle hygiene and disposing of sharps.
•
The diabetes nurse has instructed you on using insulin, including use and care of the inhaler.
•
You keep your supply of injectable insulin in the refrigerator.
•
You do not need to keep your supply of inhaled insulin in the refrigerator.
•
You are monitoring your glucose levels regularly with a fingertip test.
•
You are monitoring your glucose levels regularly with a fingertip test.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control.
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Clinical scenario 5 • •
You have Type 2 diabetes and have been taking oral tablets together with one long-acting daily insulin injection. Your doctor has told you that your glucose levels are not within the target range and in order to improve control he/she advises you to switch to a new insulin-only routine. •
You would take insulin several times per day but stop your oral tablets. •
•
Your insulin dosage may need to be adjusted from time to time.
If you can get used to the daily insulin routine, you can expect good glucose control, so the chances of your developing diabetes-related health problems would be reduced.
Treatment scenario 5x
Treatment scenario 5y
•
Based on your doctor’s advice, you have started on a new insulin routine.
•
Based on your doctor’s advice, you have started on a new insulin routine.
•
You take pre-mixed insulin twice daily, once before breakfast and once before your evening meal.
•
You take one long-acting injection at the same time each day. You take short-acting insulin before each meal, usually three times daily, using an inhalation device.
•
So normally you take two injections a day in total.
•
So normally you take one injection and three inhalations a day in total.
•
The diabetes nurse has instructed you on your new insulin routine.
•
The diabetes nurse has instructed you on your new insulin routine and on use and care of the inhaler.
•
With pre-mixed injections you have to eat once you have taken an injection, to avoid a hypo.
•
You can vary the timing of the inhalations according to when you plan to eat, and after inhalations you can eat straight away without waiting.
•
You keep your supply of injectable insulin in the refrigerator.
•
You keep your supply of injectable insulin in the refrigerator. The inhaled insulin does not need to be stored in the refrigerator.
•
• •
You are monitoring your glucose levels twice daily with a fingertip test.
•
You are monitoring your glucose levels three times daily with a fingertip test.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control.
•
You have adjusted your insulin dose to meet your body’s needs and your doctor is satisfied with your glucose control.
