1
|
Sparre T, Hansen NAB, Wernersson AS, Guarraia M. Development of an Insulin Pen is a Patient-Centric Multidisciplinary Undertaking: A Commentary. J Diabetes Sci Technol 2022; 16:617-622. [PMID: 34852662 PMCID: PMC9158249 DOI: 10.1177/19322968211058707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Thomas Sparre
- Novo Nordisk A/S, Søborg, Denmark
- Thomas Sparre, MD, PhD, Novo Nordisk A/S,
Vandtårnsvej 112, DK-2860 Søborg, Denmark.
| | | | | | | |
Collapse
|
2
|
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
|
3
|
Kurtzhals P, Gough SCL. The contributions of insulin to science in medicine. Diabet Med 2021; 38:e14623. [PMID: 34133769 PMCID: PMC9292759 DOI: 10.1111/dme.14623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/15/2021] [Indexed: 12/22/2022]
|
4
|
Affiliation(s)
- Patrick Sharp
- Adult Community Diabetes Service, Royal South Hants Hospital Southampton UK
| | - Emma Ives
- Adult Community Diabetes Service, Royal South Hants Hospital Southampton UK
| |
Collapse
|
5
|
Najmi U, Haque WZ, Ansari U, Yemane E, Alexander LA, Lee C, Demidowich AP, Motevalli M, Mackay P, Tucker C, Notobartolo C, Sartippour P, Raynor J, Zilbermint M. Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience. J Diabetes Sci Technol 2021; 15:741-747. [PMID: 33843291 PMCID: PMC8258519 DOI: 10.1177/19322968211002514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insulin pen injectors ("pens") are intended to facilitate a patient's self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. METHODS Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. RESULTS 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. CONCLUSIONS In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.
Collapse
Affiliation(s)
- Urooj Najmi
- American International School of Medicine, Atlanta, GA, USA
| | - Waqas Zia Haque
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Umair Ansari
- Pharmacy Department, Suburban Hospital, Bethesda, MD, USA
| | | | | | - Christina Lee
- Pharmacy Department, Suburban Hospital, Bethesda, MD, USA
| | - Andrew P. Demidowich
- Johns Hopkins Community Physicians at Howard County General Hospital, Columbia, MD, USA
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mahsa Motevalli
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA
| | - Periwinkle Mackay
- Department of Nursing Education, Suburban Hospital, Bethesda, MD, USA
| | - Cynthia Tucker
- Department of Nursing Education, Suburban Hospital, Bethesda, MD, USA
| | - Cindy Notobartolo
- Department of Safety, Security and Employee Health Services, Suburban Hospital, Bethesda, MD, USA
| | - Poroshat Sartippour
- Department of Management Information System, Suburban Hospital, Bethesda, MD, USA
| | | | - Mihail Zilbermint
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
- Mihail Zilbermint, MD, Johns Hopkins Community Physicians at Suburban Hospital, 8600 Old Georgetown Road, Bethesda, MD 20814, USA. ; Twitter: @Zilbermint; LinkedIn: https://www.linkedin.com/in/mishazilbermint/
| |
Collapse
|
6
|
Kurtzhals P, Nishimura E, Haahr H, Høeg-Jensen T, Johansson E, Madsen P, Sturis J, Kjeldsen T. Commemorating insulin's centennial: engineering insulin pharmacology towards physiology. Trends Pharmacol Sci 2021; 42:620-639. [PMID: 34148677 DOI: 10.1016/j.tips.2021.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 01/14/2023]
Abstract
The life-saving discovery of insulin in Toronto in 1921 is one of the most impactful achievements in medical history, at the time being hailed as a miracle treatment for diabetes. The insulin molecule itself, however, is poorly amenable as a pharmacological intervention, and the formidable challenge of optimizing insulin therapy has been ongoing for a century. We review early academic insights into insulin structure and its relation to self-association and receptor binding, as well as recombinant biotechnology, which have all been seminal for drug design. Recent developments have focused on combining genetic and chemical engineering with pharmaceutical optimization to generate ultra-rapid and ultra-long-acting, tissue-selective, or orally delivered insulin analogs. We further discuss these developments and propose that future scientific efforts in molecular engineering include realizing the dream of glucose-responsive insulin delivery.
Collapse
Affiliation(s)
- Peter Kurtzhals
- Research and Development, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark.
| | - Erica Nishimura
- Research and Development, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark
| | - Hanne Haahr
- Research and Development, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark
| | - Thomas Høeg-Jensen
- Research and Development, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark
| | - Eva Johansson
- Research and Development, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark
| | - Peter Madsen
- Research and Development, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark
| | - Jeppe Sturis
- Research and Development, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark
| | - Thomas Kjeldsen
- Research and Development, Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark
| |
Collapse
|
7
|
Gupta A, Phatak S, Rao YS, Ramesh J, Sanyal D. Consensus on Choice of Insulin Pen Devices in Routine Clinical Practice in India. Diabetes Technol Ther 2020; 22:777-786. [PMID: 32233934 DOI: 10.1089/dia.2019.0494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although insulin delivery devices are widely used by the patients, there is a paucity of published guidelines to help professionals manage their patients in insulin therapies. To provide simple and easily implementable guidelines to health care physicians on the choice of insulin delivery devices in routine clinical practice, experts in diabetes gathered together and discussed the recommendations at the National insulin Summit 2018. An ideal insulin delivery device should accurately deliver the prescribed dose of insulin and be easy to use. Recommendations are: (1) insulin should be initiated by using an insulin device if the patient seems to discontinue insulin therapy. (2) Pen devices offer accurate dosing than a syringe and vial and are associated with cost savings in the long term. (3) Switching over from syringes and vial to disposable pen devices improves adherence. (4) FlexPen® offers better accuracy, and it requires lower dose force and injection force than SoloStar® and KwikPen® (5). Durable delivery pens such as NovoPen® 4 maintain accuracy and low dose force compared with vials and syringes. (6) One pen should be used by only one patient. (7) Regular counseling on the proper use of the pen device is required regularly. This consensus-based recommendation is a useful reference tool for health care practitioners to initiate insulin therapy in patients with diabetes by using the appropriate insulin pen device.
Collapse
Affiliation(s)
- Arvind Gupta
- Director and Consultant Physician at Jaipur Diabetes Research Centre, Jaipur, Rajasthan
| | - Sanjeev Phatak
- Founder, Consultant Diabetologist, Vijayratna Diabetes Diagnostic Treatment Centre, Ahmedabad, India
| | - Y Sadashiv Rao
- Consultant Physician and Managing Director, Yalamanchi Hospital and Research Centre Private Limited, Vijayawada
| | - Jayanthy Ramesh
- Department of Endocrinology, Andhra Medical College, Visakhapatnam, India
| | - Debmalya Sanyal
- Consultant Endocrinologist, Department of Endocrinology, G.D. Diabetic Institute, R.N. Tagore Hospital, Kolkata, India
| |
Collapse
|
8
|
Easa N, Alany RG, Carew M, Vangala A. A review of non-invasive insulin delivery systems for diabetes therapy in clinical trials over the past decade. Drug Discov Today 2019; 24:440-451. [DOI: 10.1016/j.drudis.2018.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/19/2018] [Accepted: 11/15/2018] [Indexed: 02/08/2023]
|
9
|
Klonoff DC, Nayberg I, Stauder U, Oualali H, Domenger C. Half-Unit Insulin Pens: Disease Management in Patients With Diabetes Who Are Sensitive to Insulin. J Diabetes Sci Technol 2017; 11:623-630. [PMID: 27898389 PMCID: PMC5505427 DOI: 10.1177/1932296816679180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Insulin pens represent a significant technological advancement in diabetes management. While the vast majority have been designed with 1U-dosing increments, improved accuracy and precision facilitated by half-unit increments may be particularly significant in specific patients who are sensitive to insulin. These include patients with low insulin requirements and in those requiring more precise dose adjustments, such as the pediatric patient population. This review summarized functional characteristics of insulin half-unit pens (HUPs) and their effect on user experience. METHODS The literature search was restricted to articles published in English between January 1, 2000, and January 1, 2015. A total of 17 publications met the set criteria and were included in the review. RESULTS Overall, studies outlined characteristics for 4 insulin HUPs. Based on their functionality, the pens were generally similar and all met the ISO 11608-1 criteria for accuracy. However, some had specific advantageous features in terms of size, weight, design, dialing torque, and injection force. Although limited, the currently available user preference studies in children and adolescents with diabetes and their carers suggest that the selection of an HUP is likely to be influenced by a combination of factors such as these, in addition to the prescribed insulin and dosing regimen. CONCLUSIONS Insulin HUPs are likely to be a key diabetes management tool for patients who are sensitive to insulin; specific pen features may further advance diabetes management in these populations.
Collapse
Affiliation(s)
- David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, CA, USA
- David C. Klonoff, MD, Diabetes Research Institute, Mills-Peninsula Health Services, 100 S San Mateo Dr, San Mateo, CA 94401, USA.
| | - Irina Nayberg
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, CA, USA
| | | | | | | |
Collapse
|
10
|
Klug MJ, Cady K, Tate J, Rivey MP. Quality Improvement Initiative and Safety of Insulin Pen Usage in a Small Hospital. Hosp Pharm 2016. [DOI: 10.1310/hpj5102-158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The Institute for Safe Medication Practices (ISMP) has stressed the need for hospitals to re-evaluate their methods of insulin delivery in an effort to minimize complications of insulin pen use. Improper use of insulin pens can lead to adverse effects, such as hypoglycemia or blood-borne infections. Objective This study was an American Society of Health-System Pharmacists (ASHP) quality improvement activity focused on insulin pen safety in the hospital. The objective of this study was to improve insulin pen delivery and patient health and to reduce adverse effects related to insulin pen use. The purpose of the impact activity was to utilize pharmacist experts to evaluate processes related to the use of insulin pens within the hospital and then implement quality improvement efforts to address potential safety concerns. Methods Baseline and postintervention questionnaires were administered to all nursing personnel ( N = 400) to assess their analytical and procedural knowledge regarding insulin pen use and administration. Insulin administration observations and insulin pen storage and labeling audits were also conducted at the same time points in 3 patient care areas where insulin administration was common. Process improvements were made after the baseline data were collected. Results An overall improvement in insulin pen use was determined after implementation of the quality improvement plan. The greatest improvements were seen for insulin pen administration. The proper storage of insulin pens had 69% compliance at baseline that rose to 98% compliance post intervention, an improvement of 29% ( P < .01). Similarly, compliance with the return of insulin pens to proper storage areas increased by 16%, from 78% at baseline to 94% post intervention ( P < .05). Conclusion An improvement in insulin pen usage was promoted by a quality initiative in a small hospital setting. Periodic education about safety procedures along with yearly reviews for all nurses will improve the ongoing safety of insulin pen usage within the hospital.
Collapse
Affiliation(s)
- Mikayla J. Klug
- PGY-1 Pharmacy Practice Resident, Pharmacy Department, University of Montana, Community Medical Center, Missoula, Montana
| | - Kevin Cady
- Clinical Pharmacy Manager, Pharmacy Department, Community Medical Center, Missoula, Montana
| | - Janice Tate
- Diabetes Nurse Educator, Nursing Department, Community Medical Center, Missoula, Montana
| | - Michael P. Rivey
- Skaggs School of Pharmacy, University of Montana, Missoula, Montana
| |
Collapse
|
11
|
Hyllested-Winge J, Sparre T, Pedersen LK. NovoPen Echo(®) insulin delivery device. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2016; 9:11-8. [PMID: 26793007 PMCID: PMC4708877 DOI: 10.2147/mder.s59229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The introduction of insulin pen devices has provided easier, well-tolerated, and more convenient treatment regimens for patients with diabetes mellitus. When compared with vial and syringe regimens, insulin pens offer a greater clinical efficacy, improved quality of life, and increased dosing accuracy, particularly at low doses. The portable and discreet nature of pen devices reduces the burden on the patient, facilitates adherence, and subsequently contributes to the improvement in glycemic control. NovoPen Echo® is one of the latest members of the NovoPen® family that has been specifically designed for the pediatric population and is the first to combine half-unit increment (=0.5 U of insulin) dosing with a simple memory function. The half-unit increment dosing amendments and accurate injection of 0.5 U of insulin are particularly beneficial for children (and insulin-sensitive adults/elders), who often require small insulin doses. The memory function can be used to record the time and amount of the last dose, reducing the fear of double dosing or missing a dose. The memory function also provides parents with extra confidence and security that their child is taking insulin at the correct doses and times. NovoPen Echo is a lightweight, durable insulin delivery pen; it is available in two different colors, which may help to distinguish between different types of insulin, providing more confidence for both users and caregivers. Studies have demonstrated a high level of patient satisfaction, with 80% of users preferring NovoPen Echo to other pediatric insulin pens.
Collapse
|
12
|
Klonoff D, Nayberg I, Rabbone I, Domenger C, Stauder U, Oualali H, Danne T. Functional Evaluation of the Reusable JuniorSTAR® Half-Unit Insulin Pen. J Diabetes Sci Technol 2015; 9:625-31. [PMID: 25633967 PMCID: PMC4604544 DOI: 10.1177/1932296815569246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The functional performance of the JuniorSTAR(®) (Sanofi, Paris, France) half-unit insulin pen was evaluated through a series of specific objective tests to assess the dose accuracy, pen weight, injection force, and dialing torque. METHOD Pens (n = 60) were tested under standard atmospheric conditions with 3 different types of insulins manufactured by Sanofi (insulin glargine, insulin glulisine, and biphasic insulin isophane). The dose accuracy was tested according to the ISO 11608-1:2012 standards. Injection doses of 0.010, 0.155, and 0.300 ml were evaluated. For mean weight evaluation, the pens without the cartridge were weighed on precision balances. The injection force was measured using a texture analyzer and the dialing torque was measured using a torque meter. RESULTS JuniorSTAR met the ISO 11608-1:2012 criteria for dose accuracy as all the delivered doses were within the predefined limits for all types of insulin tested. The mean weight of the JuniorSTAR pen was 33.4 g (SD = 0.075). The mean injection force was 6.0 N (SD = 0.8), 4.3 N (SD = 0.4), and 5.1 N (SD = 0.6) for insulin glargine, insulin glulisine, and biphasic insulin isophane, respectively. The mean dialing torque was 5.09 Ncm (SD = 0.29) and 5.88 Ncm (SD = 0.53) for setting and correcting a dose, respectively. CONCLUSIONS Together with results from a previously reported usability survey, these results show that the JuniorSTAR reusable, half-unit pen is a lightweight and accurate device for insulin delivery with a dialing torque and injection force suitable for young people with type 1 diabetes.
Collapse
Affiliation(s)
- David Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, CA, USA
| | - Irina Nayberg
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, CA, USA
| | - Ivana Rabbone
- S.S.V.U. Endocrinologia e Diabetologia, Ospedale Infantile Regina Margherita, Turin, Italy
| | | | | | | | - Thomas Danne
- Kinder und Jugendkrankenhaus "Auf der Bult," Diabetes Centre for Children and Adolescents, Hannover, Germany
| |
Collapse
|
13
|
Limmroth V, Gerbershagen K. Single-use autoinjector for once-weekly intramuscular injection of IFNβ-1a. Expert Opin Drug Deliv 2014; 11:1969-78. [PMID: 25255732 DOI: 10.1517/17425247.2014.943181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION IFNβ products and glatiramer acetate are established treatment first-line options in long-term disease-modifying therapy of multiple sclerosis (MS). These self-injectable medications are used once weekly to once daily. Injection-related issues are common patient-cited reasons for nonadherence. Autoinjectors have been shown to support long-term adherence to injectable medications. The ability to self-inject in MS patients has been associated with a reduced risk of missed injections and drug discontinuation, and a beneficial effect on patient independence. AREAS COVERED The recently introduced easy-to-use prefilled once-weekly pen is a safe and effective device for intramuscular (IM) IFNβ-1a application and provides a convenient method for self-injection. We reviewed the available published evidence on the characteristics of this device. The once-weekly pen facilitates self-injection and was preferred over prefilled syringes by patients in a prospective open-label, multicenter Phase IIIb trial in MS patients who had been using IM IFNβ-1a in prefilled syringes. EXPERT OPINION The simple and safe handling, shielded short needle, single-use disposable design and virtually painless injection by the device may contribute to adherence, quality of life and independence in patients using IM IFNβ-1a.
Collapse
Affiliation(s)
- Volker Limmroth
- Klinikum Köln-Merheim, Klinik für Neurologie und Palliativmedizin , Ostmerheimer Str. 200 D-51109 Köln , Germany
| | | |
Collapse
|
14
|
Eby EL, Boye KS, Lage MJ. The association between use of mealtime insulin pens versus vials and healthcare charges and resource utilization in patients with type 2 diabetes: a retrospective cohort study. J Med Econ 2013; 16:1231-7. [PMID: 23834480 DOI: 10.3111/13696998.2013.823091] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare all-cause and diabetes-related resource utilization and healthcare charges among adults with type 2 diabetes mellitus who initiated therapy with mealtime insulin disposable pens or vials. METHODS Data were obtained from the Innovus inVision database from January 1, 2006 through June 30, 2010. Generalized linear models with a gamma distribution and log link estimated the association between medical charges and use of mealtime insulin pens vs vials in the 1 year post-index date, while generalized linear models with a negative binomial distribution estimated resource utilization. RESULTS Controlling for patient characteristics, general health, and patient copayments, insulin therapy initiation with disposable pens, compared to vials, was associated with significantly fewer all-cause hospitalizations (1.45 vs. 1.66; p < 0.0001) as well as a significantly shorter hospital length of stay (2.16 days vs. 3.53 days; p < 0.0001). Pen use, compared to vials, was also associated with significantly fewer diabetes-related hospitalizations (1.36 vs. 1.47; p < 0.0001), and shorter hospital length of stay (1.12 days vs. 1.72 days; p < 0.0001). Despite higher diabetes-related drug charges ($3593 vs. $2755; p < 0.0001) associated with the use of pens, results showed significantly lower all-cause total healthcare charges ($42,150 vs. $53,340; p < 0.0001) and significantly lower diabetes-related total healthcare charges ($12,722 vs. $14,540; p < 0.0001) for patients who initiated therapy on mealtime insulin with pens compared to vials. LIMITATIONS Data were drawn from administrative claims and included only patients with medical and outpatient prescription drug benefit coverage. Hence, the results may not be generalizable. The retrospective analyses relied on diagnostic codes to identify patients, assess patient general health, and determine other values, rather than formal, clinical assessments. The analyses did not include indirect healthcare costs. CONCLUSIONS The administration of mealtime insulin via disposable pens, compared to vials, was associated with a significant reduction in all-cause and diabetes-related resource utilization and total healthcare charges.
Collapse
Affiliation(s)
- Elizabeth L Eby
- Global Health Outcomes, Eli Lilly and Company , Indianapolis, IN , USA
| | | | | |
Collapse
|
15
|
Landfeldt E, Jablonowska B, Norlander E, Persdotter-Eberg K, Thurin-Kjellberg A, Wramsby M, Ström O. Patient preferences for characteristics differentiating ovarian stimulation treatments. Hum Reprod 2012; 27:760-9. [PMID: 22240210 DOI: 10.1093/humrep/der449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known concerning patient preferences for IVF treatments. The objective of this study was to elicit patient preferences for characteristics differentiating ovarian stimulation treatments. METHODS Women undergoing IVF were recruited from six clinics in Sweden between May 2010 and December 2010. Included patients completed a study questionnaire consisting of one contingent valuation (CV) question (with six different bids) and 16 conjoint analysis (CA) questions formulated as discrete choices between two hypothetical ovarian stimulation treatments (defined in terms of manufacturing method, method of administration, time required for administration, dose variability and hypothetical price). Patient preferences were derived using multinomial logit modelling. RESULTS The final study population consisted of 294 women (mean age of 35). Respondents were willing to pay €360 [95% confidence interval (CI): €340-€390] to receive FSH derived from DNA technology instead of highly purified extract from urine from post-menopausal women, €300 (95% CI: €280-€320) to administer the FSH using a prefilled injection pen instead of a conventional syringe, €30 (95% CI: €20-€40) per saved minute required for administration and €530 (95% CI: €500-€570) to reduce the dose variability from 10-20% to 1-2% (P< 0.001 for all estimates). The result from the CV was similar to the CA. CONCLUSIONS Women undergoing IVF place significant value on characteristics differentiating ovarian stimulation treatments. Product-specific aspects should be taken into account by decision-makers when discriminating between commercial gonadotrophins in clinical practice to align health-care decision-making with patient preferences and potentially improve the effectiveness of IVF interventions through enhanced patient satisfaction and treatment compliance. Preferences for treatment characteristics should also be considered in evaluations of ovarian stimulation products to capture their true value from a patient perspective.
Collapse
|
16
|
Abstract
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.
Collapse
|
17
|
Wray S, Armstrong R, Herrman C, Calkwood J, Cascione M, Watsky E, Hayward B, Mercer B, Dangond F. Results from the single-use autoinjector for self-administration of subcutaneous interferon beta-1a in patients with relapsing multiple sclerosis (MOSAIC) study. Expert Opin Drug Deliv 2011; 8:1543-53. [DOI: 10.1517/17425247.2011.628656] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
18
|
Oyer D, Narendran P, Qvist M, Niemeyer M, Nadeau DA. Ease of use and preference of a new versus widely available prefilled insulin pen assessed by people with diabetes, physicians and nurses. Expert Opin Drug Deliv 2011; 8:1259-69. [DOI: 10.1517/17425247.2011.615830] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
19
|
Williams AS. Analysis: linking laboratory data to human factors and inclusion of persons with disabilities in diabetes technology research. J Diabetes Sci Technol 2011; 5:1191-4. [PMID: 22027316 PMCID: PMC3208879 DOI: 10.1177/193229681100500524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this issue of Journal of Diabetes Science and Technology, Friedrichs and colleagues present a study of the injection force of four reusable insulin pens and another study of the dosing accuracy of three different insulin pens. For the study of injection force, the authors claim that lower injection force has numerous advantages for patients, including making use of pens easier for people with decreased hand strength. For the study of dosing accuracy, the authors state that dose accuracy is critical for glycemic control. Both study designs have significant strengths, including measurements of the variable of interest using two different methodologies and thorough documentation of methods and materials. However, the careful, precise measurements of injection force and dosing accuracy are not matched by equivalent precision supporting the significance of the studies. The authors do not provide any information about what measured injection force is easy or difficult for individuals with and without manual problems or what level of dosing inaccuracy is clinically significant. Therefore, the implications for practice remain unclear. Data about these and other relevant human factors are needed to provide meaningful context for laboratory measurements of diabetes technologies. Furthermore, researchers conducting studies of diabetes technology that include human subjects should intentionally recruit persons with disabilities so diabetes care professionals can know whether and how technical information about diabetes technology applies to the full range of patients, including those with disabilities.
Collapse
Affiliation(s)
- Ann S Williams
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106, USA.
| |
Collapse
|
20
|
Comparison of Preference for NovoPen® 4 With Previous Insulin Pen Treatments After 12 Weeks in Adult Patients With Type 1 and Type 2 Diabetes: A Multicenter Observational Study. Clin Ther 2011; 33:346-57. [DOI: 10.1016/j.clinthera.2011.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2011] [Indexed: 11/21/2022]
|