Development of an Insulin Pen is a Patient-Centric Multidisciplinary Undertaking: A Commentary

The goal of human-centered insulin pen design is to relieve the treatment burden of a chronic condition and help affected individuals to feel free of disease. The patient as well as their entire ecosystem should be considered. At Novo Nordisk A/S, we believe that embedding human-centered design at the heart of our development processes is best achieved with multidisciplinary experts in-house to work alongside product development teams and, importantly, the end user. Novo Nordisk introduced the first commercially available insulin pen in 1985 and has continued to develop reusable/durable and prefilled insulin pens to meet different patient needs, through to the latest NovoPen 6 and NovoPen Echo Plus with SMART technology. Human-centered design is essential for delivering meaningful and practical solutions for individuals with diabetes.

The Role of Human-Centered Design in Insulin Pen Innovation and the Future of Insulin Delivery

Insulin pens have made a dramatic impact on diabetes care, with evidence suggesting that they promote performance of self-care and reduce negative health outcomes for people with diabetes. Human-centered design (HCD), practiced by IDEO for over 40 years and together with Eli Lilly for over 15 years, has helped to design insulin pens that evolved with the needs of people with diabetes. HCD employs unique methods that help to uncover people's needs and design with them in mind. The future of diabetes care is bright with the ongoing application of HCD methodology in this space.

What can we learn from patient-reported outcomes of insulin pen devices?

Although a variety of effective treatment options are available for patients with type 1 or type 2 diabetes, many patients in the United States have difficulty reaching their glycemic goals. Patient adherence to insulin therapy, which often involves self-administered subcutaneous injections of insulin using either a vial and syringe or an insulin pen device, is often poor. Various factors associated with the type of injection device have been shown to influence the rate of patient adherence to insulin therapy. This article reviews patient-reported outcome (PRO) evidence from pediatric and adult studies that compared insulin pen devices with vial and syringe use. In a majority of these cases, patients preferred the pen devices over vial and syringe, stating advantages such as ease of use, convenience, greater confidence in their ability to properly administer the drug, and a greater perceived social acceptance. The pens were considered less painful than syringes and were associated with less needle fear. In addition, PRO evidence has directed pen technology design, leading to development of more advanced insulin pen devices. By appreciating the correlation between adherence to insulin regimens and a patient's device preference, clinicians can make improved treatment recommendations to facilitate achievement and maintenance of glycemic targets.

Patient Acceptance, Ease of Use, and Preference for Norditropin NordiFlex with NordiFlex PenMate: Results from an Open-Label, User Survey of Everyday Use

In this 12-week open-label, uncontrolled study, patients (n = 85; mean [SD] age 11.2 [3.95] years) were trained to use an injection device with an automatic needle insertion accessory (NordiFlex/NordiFlex PenMate: Novo Nordisk A/S, Bagsvaerd, Denmark) for growth hormone (GH) injection. The opinions of patients and the physicians/nurses who trained patients on device were recorded by questionnaire. Most (88.4%) patients reported that the device was “very easy/easy" to use. The majority (82.4%) of patients were “very satisfied/satisfied" with the device and 64% wished to continue its use. Device training instructions were reported as “very easy/easy" by 96.1% of physicians/nurses, and 65.8% of participants could use the device after ≤10-minute training. In this study, NordiFlex PenMate was well accepted by patients and medical staff. Patients had a high opinion of the device and over half wished to continue its use. High patient acceptance may facilitate treatment adherence optimizing treatment outcomes.

A review of 25 years' experience with the NovoPen family of insulin pens in the management of diabetes mellitus

NovoPen, the first insulin pen, was introduced in 1985. This review article is an update of a review paper published in 2006 on 20 years' use of the NovoPen family of insulin pens in the management of diabetes mellitus. The literature searches conducted in the earlier review article were updated with search results for new articles published since April 2005. This was followed by an iterative search of references cited in identified publications and by searches of abstracts from proceedings of major international diabetes conferences since 2005. Most of the original studies identified in the 2006 review showed that insulin regimens using the NovoPen family of insulin pens were at least as effective (and in some cases superior) in maintaining glycaemic control and were as safe (in terms of hypoglycaemia) as conventional insulin regimens employing vials and syringes. Most patients preferred the various NovoPen insulin pens over vials and syringes, with some evidence suggesting that the use of discreet devices, such as those of the NovoPen family, facilitates intensive insulin therapy regimens, thereby helping to improve lifestyle flexibility. The new search results showed that the current generation of the device for the adult population, NovoPen 4, retains these benefits and further meets patients' needs by improving ease of use, convenience and discretion, which may be particularly important for those with manual dexterity, visual or auditory impairments. There was also evidence that healthcare professionals would be more likely to recommend NovoPen 4 to their patients than other devices. The recently introduced NovoPen Echo, designed specifically for the paediatric population, combines half-increment dosing with a memory function that can be used to retrieve information about the time and amount of the last dose, potentially reducing the fear of double dosing or missing a dose. Evidence obtained from the new searches suggested that paediatric patients, their parents and healthcare professionals were highly satisfied with NovoPen Echo overall, with most paediatric patients rating it their favourite pen compared with other insulin pens. In conclusion, new data published over the last 5 years on the use of NovoPen devices add to the large body of published evidence supporting the patient-related benefits of durable insulin injection pens in the treatment of diabetes since the first such pen was introduced in 1985. Together, the benefits of NovoPen are considered likely to improve both patients' quality of life and their compliance with therapy.

Practical aspects of insulin pen devices

Insulin pen devices have several advantages over the traditional vial-and-syringe method of insulin delivery, including improved patient satisfaction and adherence, greater ease of use, superior accuracy for delivering small doses of insulin, greater social acceptability, and less reported injection pain. In recent years, pens have become increasingly user-friendly, and some models are highly intuitive to use, requiring little or no instruction. Despite this progress, uptake of these devices in the United States has not matched that in many other areas of the world. There is a need for improved awareness of the current characteristics of insulin pen devices among United States health care professionals. Knowledge of the design improvements that have been incorporated into pens, both to address patient needs and as a result of the improved technology behind the device mechanics, is essential to promoting the use of insulin pen devices. This review highlights some of the practical aspects of pen use and discusses the factors to be considered when selecting among different insulin pens.

Evolution of diabetes insulin delivery devices

The first manufactured insulin pump was introduced in the 1970s and the first insulin pens in 1985; since then, many improvements have been made to both devices. The advantages of pens over syringes have been confirmed in numerous studies and include greater accuracy, ease of use, patient satisfaction, quality of life, and adherence. United States claims database analyses indicate that the improved adherence made possible by use of an insulin pen has the potential to reduce diabetes care costs when compared with using a vial and syringe. Features of certain advanced pump models include the ability to connect wirelessly to a blood glucose meter or to a subcutaneous interstitial glucose sensor for semicontinuous glucose-driven insulin rate adjustment. A new trend in the design of insulin pumps is the tubing-free patch pump that adheres directly to the skin. The low rate of insulin pen usage in the United States compared with European countries and the fact that many patients report that they are not offered the option of an insulin pen by their physician suggest that there is a need to increase patient and provider awareness of the currently available devices for insulin administration.

A Review of 20??Years??? Experience with the Novopen?? Family of Insulin Injection Devices

NovoPen, the first insulin pen injector, was introduced in 1985. This article reviews the published evidence over two decades of use of the NovoPen family of injection devices in diabetes management. A search for NovoPen publications from 1985 onwards was conducted in the following databases: MEDLINE/PubMed, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstract Reviews and Effects, and Cochrane Controlled Trials Register. Publications were examined and underwent a selection process to identify studies of NovoPen devices (NovoPen [1], NovoPen 2, NovoPen 1.5 and NovoPen 3) in the diabetes/insulin therapy area that contained evidence of the effects of NovoPen in a variety of categories. Of the studies identified, most showed that insulin regimens using the NovoPen family of devices are at least as effective (and in some cases superior) in maintaining glycaemic control and are as safe (in terms of hypoglycaemia) as conventional insulin regimens employing syringes. The published evidence identified also showed that insulin administration via NovoPen devices was for most patients easier, more convenient and quicker than with conventional syringes and that most patients preferred the various NovoPen devices over syringes. There was also some evidence that the use of discreet devices, like those of the NovoPen family, facilitates adherence to intensive insulin therapy regimens, helps to improve lifestyle flexibility and reduces injection pain compared with conventional syringe-based regimens. Together these benefits of NovoPen devices are considered likely to improve both patients' quality of life and compliance with therapy. In conclusion, a large body of published evidence accumulated over the past two decades testifies to the patient-related benefits of the NovoPen family of insulin injection devices in the treatment of diabetes.