1
|
Kahr Rasmussen N, Berg B, Christiansen ASL, Neergaard JS, Ter-Borch G, Hildebrand EA, Gonczi M, Sparre T. The Concizumab Pen-Injector is Easy to Use and Preferred by Hemophilia Patients and Caregivers: A Usability Study Assessing Pen-Injector Handling and Preference. Patient Prefer Adherence 2024; 18:1713-1727. [PMID: 39161804 PMCID: PMC11330755 DOI: 10.2147/ppa.s470091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/10/2024] [Indexed: 08/21/2024] Open
Abstract
Introduction Concizumab is a once-daily prophylactic treatment developed for patients with hemophilia A or B (HA/HB) with or without inhibitors. It is the first treatment for hemophilia patients to be delivered subcutaneously using a pre-filled, multi-dose pen-injector with a 4 mm, 32 G needle. Aim To investigate patient and caregiver handling and preference for the concizumab pen-injector compared with current injection systems used to treat hemophilia. Methods This preference and handling study was conducted in accordance with authority guidelines for approval of new devices and included adults and adolescents with HA/HB with or without inhibitors and caregivers currently administering factor replacement therapy or factor VIII mimetic (emicizumab) therapy. All participants underwent a training session, followed by a test session during which participants independently administered a single pen-injection into an injection pad or manikin. Time to train, time to prepare and inject, and number of complete independent injections handling the pen were assessed. Participants evaluated handling and preference via the Hemophilia Device Handling and Preference Assessment Questionnaire. Results 80 participants (44 adults, 21 adolescents, 15 caregivers) currently using factor replacement therapy (n=41, 51%) or emicizumab (n=39, 49%) participated. Average training time and time to complete an injection were 7 min 49s and 1 min 21s. In total, 98% of independent complete injections were achieved at first attempt. 98% (n=78; 95% confidence interval [CI] 91-100%) of participants assessed the pen-injector as either "easy" or "very easy" to use. 88% of participants preferred the pen-injector (n=70; 95% CI 78-94%) over their current injection system, and 9% (n=7) reported "no preference". Conclusion Participants found the concizumab pen-injector easy to learn and easy to use and preferred it over their current injection systems.
Collapse
Affiliation(s)
| | - Birgitte Berg
- Clinical Operations, Novo Nordisk A/S, Søborg, Denmark
| | | | | | | | | | | | - Thomas Sparre
- Medical & Science Innovation, Novo Nordisk A/S, Søborg, Denmark
| |
Collapse
|
2
|
Sparre T, Hammershøy L, Steensgaard DB, Sturis J, Vikkelsøe P, Azzarello A. Factors Affecting Performance of Insulin Pen Injector Technology: A Narrative Review. J Diabetes Sci Technol 2023; 17:290-301. [PMID: 36540004 PMCID: PMC10012375 DOI: 10.1177/19322968221145201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Insulin treatment is an essential hormone replacement therapy for the survival of people with type 1 diabetes and is often used for treatment in type 2 diabetes, particularly as the disease progresses. Advances in insulin therapy have been made since its discovery, including production of human insulin and development of insulin analogs with improved efficacy and safety profiles. The different types of available insulin formulations allow health care professionals to personalize treatment to an individual's needs. Generally, insulin requires parenteral administration via subcutaneous injection owing to very low oral bioavailability. METHODS This article reviews the human, technological, economical, and regulatory factors affecting the performance of insulin pens and the relationship between them. Opportunities and challenges that insulin pen injections may encounter in the future are also considered. RESULTS Insulin delivery devices, together with other factors, influence dose accuracy, convenience, and quality of life, contributing to easier medication administration with high efficacy and safety. For patients, ease of use, fast and accurate drug delivery, and painless injection are the most valuable features of an insulin injection device. For manufacturers, technological feasibility and economic viability also need to be considered when developing injection devices. CONCLUSION Insulin pen injectors are generally preferred over vial and syringe, although access may be limited in some health care systems. Insulin pen injectors can adapt to different insulin regimens and formulations and have the potential to acquire dosing data in real time.
Collapse
Affiliation(s)
- Thomas Sparre
- Novo Nordisk A/S, Søborg, Denmark
- Thomas Sparre, MD, PhD, Novo Nordisk A/S,
Vandtårnsvej 112, Søborg 2860, Denmark.
| | | | | | | | | | | |
Collapse
|
3
|
Masierek M, Nabrdalik K, Janota O, Kwiendacz H, Macherski M, Gumprecht J. The Review of Insulin Pens-Past, Present, and Look to the Future. Front Endocrinol (Lausanne) 2022; 13:827484. [PMID: 35355552 PMCID: PMC8959107 DOI: 10.3389/fendo.2022.827484] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/02/2022] [Indexed: 12/17/2022] Open
Abstract
Currently, there are about 150-200 million diabetic patients treated with insulin globally. The year 2021 is special because the 100th anniversary of the insulin discovery is being celebrated. It is a good occasion to sum up the insulin pen technology invention and improvement which are nowadays the leading mode of an insulin delivery. Even though so many years have passed, insulin is still administered subcutaneously, that is why devices to deliver it are of great importance. Insulin pens have evolved only through the last decades (the reusable, durable pens, and the disposable, prefilled pens) and modern smart insulin pens have been developed in the last few years, and both types of the devices compared to traditional syringes and vials are more convenient, discrete in use, have better dosing accuracy, and improve adherence. In this review, we will focus on the history of insulin pens and their improvement over the previous decades.
Collapse
Affiliation(s)
- Małgorzata Masierek
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Nabrdalik
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- *Correspondence: Katarzyna Nabrdalik,
| | - Oliwia Janota
- Students’ Scientific Association by the Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Hanna Kwiendacz
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Maksymilian Macherski
- Students’ Scientific Association by the Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
4
|
Vermeire S, D'heygere F, Nakad A, Franchimont D, Fontaine F, Louis E, Van Hootegem P, Dewit O, Lambrecht G, Strubbe B, Baert F. Preference for a prefilled syringe or an auto-injection device for delivering golimumab in patients with moderate-to-severe ulcerative colitis: a randomized crossover study. Patient Prefer Adherence 2018; 12:1193-1202. [PMID: 30013330 PMCID: PMC6039065 DOI: 10.2147/ppa.s154181] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Simponi® (golimumab, MSD) is a fully human monoclonal antibody against tumor necrosis factor alpha administered subcutaneously using an autoinjector or a prefilled syringe. This study examined preference for administration of golimumab by autoinjector or prefilled syringe in patients with moderate-to-severe ulcerative colitis (UC). PATIENTS AND METHODS This was a multicenter, open-label, randomized crossover trial (EudraCT no 2014-000656-29). Patients with moderate-to-severe UC were randomized 1:1 to receive 2 subcutaneous injections of 50 mg golimumab with the autoinjector followed by 2 injections of 50 mg with the prefilled syringe or the same 4 injections administered in the opposite order. Patients assessed preference, ease of use, and discomfort immediately after the injections and 2 weeks later. RESULTS Ninety-one patients were included (median age=42.7 years [range, 19.7-93.7]; 58% male). The autoinjector was preferred by 76.9% of patients immediately after injections and by 71.4% 2 weeks later. The autoinjector was more often considered extremely easy or easy to use (94.5%) than the prefilled syringe (73.6%). Moderate discomfort or worse was reported by more patients when using the prefilled syringe (20.9%) than when using the autoinjector (5.5%), and severe discomfort or discomfort preventing injection of future doses was reported by 8.8% for the pre-filled syringe but not at all when using the autoinjector. A favorable or extremely favorable overall impression was reported by 89.0% for the autoinjector and 72.5% for the prefilled syringe. CONCLUSION Most patients with moderate-to-severe UC preferred to self-administer golimumab with the autoinjector over a prefilled syringe.
Collapse
Affiliation(s)
- Séverine Vermeire
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium,
| | | | - Antoine Nakad
- Department of Gastroenterology, CHWAPI, Tournai, Belgium
| | | | | | - Edouard Louis
- Department of Gastroenterology, University Hospital CHU Sart Tilman, Liège, Belgium
| | | | - Olivier Dewit
- Department of Gastroenterology, UCL St Luc, Brussels, Belgium
| | - Guy Lambrecht
- Department of Gastroenterology, AZ Damiaan, Oostende, Belgium
| | | | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare-Menen, Belgium
| |
Collapse
|
5
|
Schneider AE, Lange J. Pen devices for self-injection: contrasting measured injection force with users' perceived ease of injection. Expert Opin Drug Deliv 2017; 15:115-125. [PMID: 29226723 DOI: 10.1080/17425247.2018.1415884] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Past research has emphasized injection force as a clinically highly relevant technical attribute of pen devices. However, little work has been conducted to relate these results to in-use studies. This article explores whether and how differences in pen injection force profiles influence users' self-reported perceived ease of injection and preferences. METHODS Three different pen systems were subjected to measurements of injection force using an automated mechanical set-up followed by a simulated use study where users assessed perceived ease of injection. MAIN OUTCOMES MEASURE Outcomes were measured by fitting data of measured injection force and perceived ease of injection using a linear model. RESULTS Although mechanical testing revealed significant differences between the three pen's measured injection forces these differences were not directly perceived by users in simulated injection studies. CONCLUSION The article bridges literature on injection force measurement and simulated use. It reveals how users' perceived ease of injection is less sensitive to measured injection forces than prior research has assumed. Thus, future research should holistically integrate patient feedback in new device development. Key limitations of this work are the low number of participants in the simulated use study and the fact that the ease of injection was assessed indirectly.
Collapse
|
6
|
Gudiksen N, Hofstätter T, Rønn BB, Sparre T. FlexTouch: An Insulin Pen-Injector with a Low Activation Force Across Different Insulin Formulations, Needle Technologies, and Temperature Conditions. Diabetes Technol Ther 2017; 19:603-607. [PMID: 28704062 PMCID: PMC5653146 DOI: 10.1089/dia.2017.0121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
FlexTouch® (Novo Nordisk A/S, Bagsvaerd, Denmark) is a pen-injector with a torque spring mechanism requiring a low activation force. This laboratory-based study compared the activation force of FlexTouch during the injection of insulin with different needles and at temperature conditions within the range at which the device is recommended for use. Using a tensile tester, activation force was measured at maximum dose settings for insulin detemir (100 U/mL) and insulin degludec (100 and 200 U/mL) at standard (23°C ± 5°C), cool (5°C ± 3°C), and warm (30°C ± 2°C) conditions. Activation force was measured with two 32-gauge needles differing in internal diameter at standard conditions. At standard, cool, and warm conditions, estimated mean activation forces with 95% confidence interval were 5.71 newtons (N) (5.63-5.79), 5.94 N (5.83-6.06), and 5.69 N (5.58-5.80) with insulin detemir, 5.53 N (5.45-5.62), 5.56 N (5.44-5.67), and 5.33 N (5.22-5.44) with 100 U/mL insulin degludec, and 5.53 N (5.45-5.61), 5.83 N (5.71-5.94), and 5.56 N (5.45-5.68) with 200 U/mL insulin degludec, respectively. Mean activation forces were observed to be low with very small variability between measurements; however, the differences between insulins and temperature conditions were statistically significant. The activation force required by FlexTouch remained low across all situations tested. The differences between activation force needed with different insulins and temperature conditions were small and unlikely to be clinically meaningful.
Collapse
Affiliation(s)
| | | | | | - Thomas Sparre
- Global Development, Medical & Science, Devices & Titration, Novo Nordisk A/S, Søborg, Denmark
| |
Collapse
|
7
|
Bailey TS, Stone JY. A novel pen-based Bluetooth-enabled insulin delivery system with insulin dose tracking and advice. Expert Opin Drug Deliv 2017; 14:697-703. [PMID: 28359171 DOI: 10.1080/17425247.2017.1313831] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Diabetes is growing in prevalence internationally. As more individuals require insulin as part of their treatment, technology evolves to optimize delivery, improve adherence, and reduce dosing errors. Insulin pens outperform vial and syringe in simplicity, dosing accuracy, and user preference. Bolus advisors improve dosing confidence and treatment adherence. The InPen System offers a novel approach to treatment via a wireless pen that syncs to a mobile application featuring a bolus advisor, enabling convenient insulin dose tracking and more accurate bolus advice among other features. Areas covered: Existing technology for insulin delivery and bolus advice are reviewed. The mechanics and functionality of the InPen device are delineated. Findings from formative testing and usability studies of the InPen system are reported. Future directions for the InPen system in the treatment of diabetes are discussed. Expert opinion: Diabetes management is complex and largely data-driven. The InPen System offers a promising new opportunity to avail insulin pen-users of features known to improve treatment efficacy, which have otherwise primarily been available to those using pumps. Given that the majority of insulin users do not use insulin pumps, the InPen System is poised to improve glucose control in a significant portion of the diabetes population.
Collapse
|
8
|
Abstract
In this issue, Pohlmeier et al report on a device assessment study in insulin-naïve patients with type 2 diabetes, to investigate the ease of use/learning and patient preference of the new prefilled U300 insulin glargine injection pen. Human factor studies are required by regulatory agencies and should ensure the proper use of the device in the context of the provided instructions. The patients found the device easy to learn/use and had a stable treatment satisfaction despite introduction of injection treatment. The lack of a control arm, the short duration, and the small sample size make it difficult to translate these results into clinical practice. It is encouraging to know, however, that the new pen is accepted by one of the intended patient populations.
Collapse
Affiliation(s)
- Andreas Pfützner
- Pfützner Science & Health Institute, Mainz, Germany
- Andreas Pfützner, MD, PhD, Pfützner Science & Health Institute, Parcusstr 8, Mainz D-55116, Germany.
| |
Collapse
|
9
|
Affiliation(s)
- Luigi F Meneghini
- 1 Division of Endocrinology, UT Southwestern Medical Center , Dallas, Texas
- 2 Global Diabetes Program, Parkland Health & Hospital System , Dallas, Texas
| | | |
Collapse
|
10
|
Wang R, Bu YP. Application of clinical nursing pathway in insulin injection in patients with type 2 diabetes. Shijie Huaren Xiaohua Zazhi 2015; 23:1530-1534. [DOI: 10.11569/wcjd.v23.i9.1530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the application of clinical nursing pathway in insulin injection in patients with type 2 diabetes.
METHODS: One hundred and six patients with type 2 diabetes were randomly divided into either an experiment group (53 cases) or a control group (53 cases). The control group was cared by routine nursing mode during insulin injections, and the experiment group was cared using clinical nursing pathway. The hospital stay, hospitalization expense, blood glucose level, incidence of hypoglycemia, insulin related knowledge, mastery of injection skill, and nursing satisfaction were compared for the two groups.
RESULTS: The hospital stay and hospitalization expense for the experiment group were significantly lower than those for the control group (12.49 d ± 3.08 d vs 14.41 d ± 3.66 d, 11036.85 ± 3166.15 vs 14438.22 ± 4057.12, P < 0.05). The fasting blood glucose and blood sugar 2 h after meals for the experiment group were significantly lower than those for the control group (7.05 mmol/L ± 0.86 mmol/L vs 7.66 mmol/L ± 0.98 mmol/L, 9.36 mmol/L ± 1.34 mmol/L vs 10.48 mmol/L ± 1.59 mmol/L, P < 0.05). The rate of hypoglycemia for the experiment group was significantly lower than that for the control group (3.77% vs 15.09%, P < 0.05). The rates of awareness of insulin related knowledge and mastery of injection skill for the experiment group were significantly higher than those for the control group (90.57% vs 75.47%, 94.34% vs 81.13%, P < 0.05). The rate of satisfaction to nursing for the experiment group was significantly higher than that for the control group (96.23% vs 83.02%, P < 0.05).
CONCLUSION: The implementation of clinical nursing pathway in insulin injection in patients with type 2 diabetes can help control blood sugar, reduce hospital stay and hospitalization cost, increase the awareness of insulin related knowledge and the mastery of the injection skill, and increase the satisfaction to nursing.
Collapse
|
11
|
Pafili K, Papanas N. The importance of patient compliance with insulin pens: how can a new user-friendly pen help? Expert Opin Drug Deliv 2014; 11:629-32. [DOI: 10.1517/17425247.2014.894505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
12
|
Götzche D, Rasmussen BØ, Pedersen MT, Sparre T, Bucher D, Niemeyer M. Injection force and dose accuracy of FlexTouch for the delivery of a new basal insulin. Expert Opin Drug Deliv 2013; 10:1613-9. [DOI: 10.1517/17425247.2013.863276] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
13
|
Oyer D, Niemeyer M, Moses A. Empowering people with diabetes: improving perceptions and outcomes with technical advances in insulin pens. Postgrad Med 2013; 124:110-20. [PMID: 23095431 DOI: 10.3810/pgm.2012.09.2587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
Collapse
Affiliation(s)
- David Oyer
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | | | | |
Collapse
|
14
|
Lajara R, Guerrero G, Thurman J. Healthcare professional and patient perceptions of a new prefilled insulin pen versus vial and syringe. Expert Opin Drug Deliv 2012; 9:1181-96. [DOI: 10.1517/17425247.2012.721774] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|