Needle with a novel attachment versus conventional screw-thread needles: a preference and usability test among adults with diabetes and impaired manual dexterity

Simplicity, safety, and acceptability of insulin pen use versus the conventional vial/syringe device in patients with type 1 and type 2 diabetes mellitus in Lebanon

BACKGROUND

The aim of the study was to evaluate the simplicity, safety, patients' preference, and convenience of the administration of insulin using the pen device versus the conventional vial/syringe in patients with diabetes.

METHODS

This observational study was conducted in multiple community pharmacies in Lebanon. The investigators interviewed patients with diabetes using an insulin pen or conventional vial/syringe. A total of 74 questionnaires were filled over a period of 6 months. Answers were entered into the Statistical Package for Social Sciences (SPSS) software and Excel spreadsheet. t-test, logistic regression analysis, and correlation analysis were used in order to analyze the results.

RESULTS

A higher percentage of patients from the insulin pen users group (95.2%) found the method easy to use as compared to only 46.7% of the insulin conventional users group (P 0.001, relative risk [RR]: 2.041, 95% confidence interval [CI]: 1.178-3.535). Moreover, 61.9% and 26.7% of pen users and conventional users, respectively, could read the scale easily (P 0.037, RR 2.321, 95% CI: 0.940-5.731), while 85.7% of pen users found it more convenient shifting to pen and 86.7% of the conventional users would want to shift to pen if it had the same cost. Pain perception was statistically different between the groups. A much higher percentage (76.2%) of pen users showed no pain during injection compared to only 26.7% of conventional users (P 0.003, RR 2.857, 95% CI: 1.194-6.838).

CONCLUSION

The insulin pen was significantly much easier to use and less painful than the conventional vial/syringe. Proper education on the methods of administration/storage and disposal of needles/syringes is needed in both groups.

A Randomized Clinical Trial of Insulin Glargine and Aspart, Compared to NPH and Regular Insulin in Children with Type 1 Diabetes Mellitus

OBJECTIVE

Appropriate treatment of patients with Type 1 diabetes mellitus (T1DM) is necessary to avoid further complications. This study was performed to compare the efficacy of insulin Glargine and Aspart with NPH insulin and regular insulin regimen in a group of children with T1DM.

METHODS

Forty patients with T1DM were enrolled in this study. During run-in, all subjects were treated with conventional therapy consisting of twice-daily NPH and thrice-daily regular. Following randomization, 20 subjects received Glargine and Aspart and 20 subjects received NPH and Regular insulin.

FINDINGS

Mean HbA1c was 8.8% and 8.6% at first and 8.4% and 8.2% at the end of study for subjects randomized initially to Glargine and Aspart and for those randomized to NPH and Regular, respectively (P>0.05). Mean fasting blood glucose (FBS) of the subjects randomized initially to Glargine and Aspart was 217±101 mg/dL, with no significant difference to 196±75 mg/dL for those randomized to NPH and Regular (P=0.48). This was also true at the end of the study. The difference in total cholesterol and triglyceride between the two groups in the beginning of study and at the end did not show any significance.

CONCLUSION

The current study showed no significant difference in glycemic control [Glycated hemoglobin (HbA1c) and FBS] and lipid profile (total cholesterol and triglyceride) between two regimes.

Patient preferences for the treatment of type 2 diabetes: a scoping review

BACKGROUND

As more studies report on patient preferences, techniques are needed to identify, assess and, eventually, synthesize results from a diverse set of methodologies. Data on patient preferences are valuable to decision makers in a variety of ways. Preferences for outcomes can be used to inform decision and cost-effectiveness models, while preferences for treatments can inform patient-centered outcomes research (PCOR) and patient-centered care.

OBJECTIVES

This project sought to identify and assess the literature reporting on the treatment preferences of adult patients with type 2 diabetes. In addition to cataloging the preference elicitation methods used, we developed and assessed a novel quality assessment checklist for preference-based studies.

DATA SOURCES

PubMed, EMBASE, CINAHL, and EconLit databases were searched to identify studies examining patient preferences for medications for type 2 diabetes studies published since inception of each database.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS

The review protocol specified inclusion of studies reporting diabetes-treatment preferences among adults with type 2 diabetes, using a range of preference measurement methods. Studies were excluded if participants were not patients with type 2 diabetes and if treatments were not pharmacological therapies targeting glycemic control, or if no primary preference information was collected. Two investigators independently reviewed titles, abstracts, and articles sequentially to select studies for data abstraction based on the inclusion and exclusion criteria. Disagreements were resolved by consensus.

STUDY APPRAISAL AND SYNTHESIS METHODS

Data on study country, year, number of respondents, preference elicitation method, number of attributes, subgroup analyses, and funding source were abstracted into standardized tables. A novel checklist (PREFS) was used to assess the data quality and validity across different types of preference studies by assessing the following: purpose of the study; respondent sampling; explanation of preference assessment methods; findings reported for total sample; and significance testing. Each item was scored, and an aggregate score was then calculated (ranging from 0 to 5).

RESULTS

Of the 2,100 unique citations, 61 met the inclusion criteria. The studies used conjoint analysis (n = 10), time trade-off (n = 6), standard gamble (n = 2), contingent valuation (n = 1), other stated preference methods (n = 39), and revealed preferences (n = 5). Sample sizes ranged from 27 to 14,033, with an average of 562 respondents, and two-thirds included a subgroup analysis. Most studies were conducted in one country, predominantly the USA (n = 27), UK (n = 14), Canada (n = 10), and Germany (n = 7), while 14 were conducted in multiple (2-18) countries across two or more countries. There was an increase in the annual rate of studies published over time from the time of the first publication in 1985 (p = < 0.01). Most (n = 52) studies were funded by pharmaceutical or device companies, with government, academic, association, and hospital sources also funding studies. One study met all five of the PREFS criteria and 12 met four; yet four studies met none of the criteria. The average was 27.

LIMITATIONS

Currently, preferences reviews are limited by the mixed quality in the reporting of studies, the publication bias inherent in the literature, a lack of guidelines to conduct various methods, and the difficulty of synthesizing results from different studies. Our study is also limited by its focus on English language articles.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

This study provides the first systematic evaluation of the methods used in the broad existing body of research into patient preferences for type 2 diabetes medications and can serve as a primary source of information for decision makers. Future work is necessary to assess the utility of the results of reviews of preference information and to develop best-practice guidelines for the reporting of, and methods of conducting, preference studies and systematic reviews of such studies.

REGISTRATION

This systematic review was registered with PROSPERO (registration number CRD42012002285).

Empowering people with diabetes: improving perceptions and outcomes with technical advances in insulin pens

For people with diabetes treated with insulin, the development of insulin pens has led to important advantages compared with the use of vials and syringes. Insulin pens are associated with improved ease of use, user confidence, treatment satisfaction, and quality of life compared with vials and syringes. Continual improvements to insulin pen designs to further enhance usability and improve patient perceptions may help to lower patients' resistance to initiating insulin therapy and further improve treatment adherence. This article reviews recent developments in prefilled insulin pens that may assist health care professionals when considering insulin-delivery devices to recommend to their patients.

Needle with a novel attachment versus conventional screw-thread needles: a preference and ease-of-use test among children and adolescents with diabetes

BACKGROUND

This usability test investigated the overall preference and usability of the novel NovoTwist® insulin pen needle versus conventional screw-thread needles, when used with Next Generation FlexPen®, in children and adolescents with diabetes.

METHODS

This was an open-label, randomized, crossover usability test in children and adolescents with type 1 diabetes who administered insulin with an insulin pen. Test needles were NovoTwist and the participant's current screw-thread needle (or NovoFine® needle). Following instruction, participants attached the needle to Next Generation FlexPen, made an injection into a foam cushion, and detached the needle. This procedure was conducted three times with both needles in a random order. Responses to 13 questions on user experience with each needle (including overall preference, ease of attachment/detachment of needle/cap, handling, learning, confidence in attachment, and convenience of use) were subsequently recorded on a six-point rating scale (1 = very difficult; 6 = very easy).

RESULTS

Fifteen children aged ≥ 6 to ≤ 12 years and 15 adolescents aged ≥ 13 to ≤ 17 years participated in the test. A significantly higher proportion of children and adolescents (77%) indicated that they would prefer to use NovoTwist compared with screw-thread needles (p = .005). NovoTwist was preferred by most children and adolescents for overall ease of use (77%; p = .005), for ease of attachment (87%; p < .001) and detachment (83%; p < .001), and as the most appropriate needle to handle for daily injections (73%; p = .016). The mean rating for confidence in correct needle attachment was not significantly different between the two needle types. Seven out of eight parents of children who required assistance for their daily insulin injections stated that they would be "very likely" to allow their child to attach NovoTwist.

CONCLUSIONS

These factors may promote confidence in this needle, and thus in self-injecting, among younger patients and their parents.

Insulin administration: selecting the appropriate needle and individualizing the injection technique

INTRODUCTION

Patients with diabetes who receive insulin therapy often fail to meet their targets for metabolic control with insulin injections. Their inadequate glycemic control may be related to incorrect injection procedure.

AREAS COVERED

This review examines the latest data related to insulin injection and needle characteristics, which play an integral role in patient satisfaction. Searches of Medline and Cumulative Index to Nursing and Allied Health Literature databases were conducted. Results show that optimal insulin injection can facilitate glycemic control in pediatric and adult patients. In general, needles shorter than 8 mm are appropriate for normal weight, obese pediatric and adult patients. However, body mass index, gender, race, age and injection site can influence the depth of subcutaneous tissue and thus, the desired needle size and injection technique. Although the abdomen, thighs and buttocks are all recommended injection sites, abdominal injections disperse insulin slightly more rapidly than thigh injections.

EXPERT OPINION

Wider acceptance of needles shorter than 6 mm will occur with more evidence of their safety and efficacy, particularly in children. Development of shorter and thinner needles to make injections even easier and less burdensome may be expected in the future.