EVALUATION COMMITTEE

The Faculty Council has appointed the following adjudication committee to evaluate the thesis and the associated lecture: 

• Associate Professor Elia Gabarron, Østfold University College, Norway
• Associate Professor Antonio Martinez-Millana, Universitat Politècnica de València, Spain
• Professor Claus Graff, HST, Aalborg Universitet, Denmark (Chair)

Moderator: Associate Professor Maciej Plocharski, HST, Aalborg Universitet, Denmark

ABSTRACT

Insulin therapy will become a key treatment for many people with type 2 diabetes, yet adherence within this population is not well understood due to limited adherence data availability. Currently, there is no established gold-standard method for assessing insulin adherence. As a result, adherence rates reported in the literature vary widely, and healthcare professionals face challenges in identifying cases and types of non-adherence.
The primary aim of this doctoral thesis was to assess basal insulin adherence in people with type 2 diabetes, a step that holds promise for improving adherence and enabling timely interventions to prevent diabetic complications. This thesis comprised four studies, each presented in a separate paper.

Paper I reviewed current methods for assessing insulin adherence, recommending the use of injection data recorded by connected insulin pens to underlie adherence assessment.

Paper II demonstrated that deviation from recommended basal insulin doses impacts glycemic control, emphasizing the importance of including dose variation in adherence assessments. This parameter can be obtained by insulin injection data.

Paper III developed a three-step method for assessing adherence
through three components: overall adherence, distribution, and dose deviation, providing healthcare professionals with a more nuanced tool for evaluating adherence behaviors.

Paper IV applied this threestep method to analyze adherence levels and patterns among people with insulin-treated type 2 diabetes.

In conclusion, assessment methods based on utilizing connected insulin pens, which log injection times and dosages, allow for a more detailed and accurate assessment of adherence in type 2 diabetes.
This approach revealed that minor irregularities in dosing are common, with some people adjusting doses daily—a finding not previously documented. This three-step method enables healthcare professionals to offer tailored interventions to enhance adherence and reduce the risk of complications.