1
|
Wang W, Men L, Wang Y, Shi C, Yin H, Li H, Zhou H, Du J. Effect of needle-free injection on psychological insulin resistance and insulin dosage in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2024; 15:1379830. [PMID: 38803476 PMCID: PMC11129580 DOI: 10.3389/fendo.2024.1379830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
Background and objective Psychological insulin resistance (PIR), which refers to the reluctance of diabetic patients to use insulin, is a frequently encountered clinical issue. Needle-free injection (NFI) offers advantages in terms of expediting insulin absorption and mitigating adverse reactions related to injection. To evaluate the effects of subcutaneous injection of insulin aspart 30 with NFI on PIR and insulin dosage in patients with type 2 diabetes mellitus (T2DM). Methods Sixty-four patients with T2DM participated in this randomized, prospective, open, crossover study. Insulin aspart 30 was administered subcutaneously to each subject via QS-P NFI and Novo Pen 5 (NP) successively. The effects of NFI on PIR were analyzed. Differences in insulin dosage, glycemic variability, and injection safety were compared at similar levels of glycemic control. Results After the administration of NFI, the insulin treatment attitude scale score decreased (53.7 ± 7.3 vs. 58.9 ± 10.7, p<0.001), the insulin treatment adherence questionnaire score increased (46.3 ± 4.9 vs. 43.8 ± 7.1, p<0.001), and the insulin treatment satisfaction questionnaire score increased (66.6 ± 10.5 vs. 62.4 ± 16.5, p<0.001). At the same blood glucose level, NFI required a smaller dosage of insulin aspart 30 compared with that of NP (30.42 ± 8.70 vs. 33.66 ± 9.13 U/d, p<0.001). There were no differences in glycemic variability indices (standard deviation, mean amplitude of glycemic excursion or coefficient of variation) between the two injection methods. Compared with NP, NFI did not increase the incidence of hypoglycemia (17.2% vs. 14.1%, p=0.774), and it decreased the incidence of induration (4.7% vs. 23.4%, p=0.002) and leakage (6.3% vs. 20.3%, p=0.022) while decreasing the pain visual analog scale score (2.30 ± 1.58 vs. 3.11 ± 1.40, p<0.001). Conclusion NFI can improve PIR in patients with T2DM and be used with a smaller dose of insulin aspart 30 while maintaining the same hypoglycemic effect. Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2400083658.
Collapse
Affiliation(s)
- Weiping Wang
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lili Men
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yongbo Wang
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chunhong Shi
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Huihui Yin
- Nursing Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Han Li
- Nursing Department, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haicheng Zhou
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jianling Du
- Department of Endocrinology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
- Dalian Key Laboratory of Prevention and Treatment of Metabolic Diseases and the Vascular Complications, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
2
|
Wang Q, Zhu Q, Li N. A Scientometric Analysis and Visualization of Scientific Research and Technology Innovation in Needle-free Insulin Injection From 1974 to 2022. Clin Ther 2023; 45:881-888. [PMID: 37516566 DOI: 10.1016/j.clinthera.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/27/2023] [Accepted: 06/30/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Needle-free jet injection has to some extent improved the quality of life of patients with diabetes, but it has not been widely used. Therefore, we analyzed articles, clinical trials, and patents of needle-free insulin injection to (1) perform a systematic and comprehensive analysis of scientific research and technology innovation in needle-free insulin injection during the past 49 years (1974 to 2022) and (2) identify the status of scientific research and technology innovation, their limitations, and future trends. METHODS With a new perspective, we use scientometric tools, including co-word and word frequency analyses, text mining, and cluster network analysis, to provide a scientometric analysis and visualization of articles, clinical trials, and patents related to needle-free insulin injection delivery applications. FINDINGS Patent innovation in this field was more active than clinical research, and clinical research prevailed over basic research. Basic research and clinical trials in this field mainly involved therapy, penetration, tolerability, absorption, and pharmacokinetic properties. Drive mechanisms and needle-free injection devices were the core patent technologies in this field. IMPLICATIONS Although needle-free insulin injection has been under development for decades, its full potential has not yet been reached; needle-free injection technology is still in the growth stage. The field of needleless insulin injection is dominated by patent technology innovation.
Collapse
Affiliation(s)
- Qing Wang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qinlei Zhu
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Naishi Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; WHO Family of International Classifications Collaborating Center of China, Beijing, China.
| |
Collapse
|
3
|
Kalra S, Unnikrishnan AG, Prasanna Kumar KM, Sahay R, Chandalia HB, Saboo B, Annamalai S, Kesavadev J, Shukla R, Wangnoo SK, Baruah MP, Jacob J, Arora S, Singla R, Sharma SK, Damodaran S, Bantwal G. Addendum 1: Forum for Injection Technique and Therapy Expert Recommendations, India. Diabetes Ther 2023; 14:29-45. [PMID: 36380217 PMCID: PMC9880128 DOI: 10.1007/s13300-022-01332-x] [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: 09/22/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
With the emerging complexities in chronic diseases and people's lifestyles, healthcare professionals (HCPs) need to update their methods to manage and educate patients with chronic lifestyle disorders, particularly diabetes. The insulin injection technique (IIT), along with various parameters, must also be updated with newer methods. Forum for Injection Technique and Therapy Expert Recommendations (FITTER), India, has updated its recommendations to cover newer ways of detecting hypoglycaemia and lipohypertrophy, preventing needlestick injuries (NSIs), discouraging the reuse of insulin needles and encouraging good disposal. FITTER, India, is also introducing recommendations to calculate insulin bolus dose. These updated recommendations will help HCPs better manage patients with diabetes and achieve improved outcomes.
Collapse
|
4
|
Hong Y, Yu H, Wang L, Chen X, Huang Y, Yang J, Ren S. Transdermal Insulin Delivery and Microneedles-based Minimally Invasive Delivery Systems. Curr Pharm Des 2022; 28:3175-3193. [PMID: 35676840 DOI: 10.2174/1381612828666220608130056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/25/2022] [Indexed: 01/28/2023]
Abstract
Diabetes has become a serious threat to human health, causing death and pain to numerous patients. Transdermal insulin delivery is a substitute for traditional insulin injection to avoid pain from the injection. Transdermal methods include non-invasive and invasive methods. As the non-invasive methods could hardly get through the stratum corneum, minimally invasive devices, especially microneedles, could enhance the transappendageal route in transcutaneous insulin delivery, and could act as connectors between the tissue and outer environment or devices. Microneedle patches have been in quick development in recent years and with different types, materials and functions. In those patches, the smart microneedle patch could perform as a sensor and reactor responding to glucose to regulate the blood level. In the smart microneedles field, the phenylboronic acid system and the glucose oxidase system have been successfully applied on the microneedle platform. Insulin transdermal delivery strategy, microneedles technology and smart microneedles' development would be discussed in this review.
Collapse
Affiliation(s)
- Yichuan Hong
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, P.R. China
| | - Haojie Yu
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, P.R. China
| | - Li Wang
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, P.R. China
| | - Xiang Chen
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, P.R. China
| | - Yudi Huang
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, P.R. China
| | - Jian Yang
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, P.R. China
| | - Shuning Ren
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou 310027, P.R. China
| |
Collapse
|
5
|
Yu G, Zhang M, Gao L, Zhou Y, Qiao L, Yin J, Wang Y, Zhou J, Ye H. Far-red light-activated human islet-like designer cells enable sustained fine-tuned secretion of insulin for glucose control. Mol Ther 2022; 30:341-354. [PMID: 34530162 PMCID: PMC8753431 DOI: 10.1016/j.ymthe.2021.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 01/07/2023] Open
Abstract
Diabetes affects almost half a billion people, and all individuals with type 1 diabetes (T1D) and a large portion of individuals with type 2 diabetes rely on self-administration of the peptide hormone insulin to achieve glucose control. However, this treatment modality has cumbersome storage and equipment requirements and is susceptible to fatal user error. Here, reasoning that a cell-based therapy could be coupled to an external induction circuit for blood glucose control, as a proof of concept we developed far-red light (FRL)-activated human islet-like designer (FAID) cells and demonstrated how FAID cell implants achieved safe and sustained glucose control in diabetic model mice. Specifically, by introducing a FRL-triggered optogenetic device into human mesenchymal stem cells (hMSCs), which we encapsulated in poly-(l-lysine)-alginate and implanted subcutaneously under the dorsum of T1D model mice, we achieved FRL illumination-inducible secretion of insulin that yielded improvements in glucose tolerance and sustained blood glucose control over traditional insulin glargine treatment. Moreover, the FAID cell implants attenuated both oxidative stress and development of multiple diabetes-related complications in kidneys. This optogenetics-controlled "living cell factory" platform could be harnessed to develop multiple synthetic designer therapeutic cells to achieve long-term yet precisely controllable drug delivery.
Collapse
Affiliation(s)
- Guiling Yu
- Synthetic Biology and Biomedical Engineering Laboratory, Biomedical Synthetic Biology Research Center, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Dongchuan Road 500, Shanghai 200241, China
| | - Mingliang Zhang
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Ling Gao
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan 430061, China
| | - Yang Zhou
- Synthetic Biology and Biomedical Engineering Laboratory, Biomedical Synthetic Biology Research Center, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Dongchuan Road 500, Shanghai 200241, China
| | - Longliang Qiao
- Synthetic Biology and Biomedical Engineering Laboratory, Biomedical Synthetic Biology Research Center, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Dongchuan Road 500, Shanghai 200241, China
| | - Jianli Yin
- Synthetic Biology and Biomedical Engineering Laboratory, Biomedical Synthetic Biology Research Center, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Dongchuan Road 500, Shanghai 200241, China
| | - Yiwen Wang
- Electron Microscopy Center, School of Life Sciences, East China Normal University, Dongchuan Road 500, Shanghai 200241, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
| | - Haifeng Ye
- Synthetic Biology and Biomedical Engineering Laboratory, Biomedical Synthetic Biology Research Center, Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Dongchuan Road 500, Shanghai 200241, China.
| |
Collapse
|
6
|
Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Nikonova TV, Sukhareva OY, Pekareva EV, Ibragimova LI, Mikhina MS, Galstyan GR, Tokmakova AY, Surkova EV, Laptev DN, Kononenko IV, Egorova DN, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Gomova IS, Lipatov DV, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Klimontov VV, Mkrtumyan AM, Petunina NA, Suplotova LA, Ushakova OV, Khalimov YS, Ruyatkina LA. Diabetes mellitus type 1 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Vadim V. Klimontov
- Research Institute of Clinical and Experimental Lymphology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
| | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | | | | |
Collapse
|
7
|
Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Sukhareva OY, Galstyan GR, Tokmakova AY, Nikonova TV, Surkova EV, Kononenko IV, Egorova DN, Ibragimova LI, Shestakova EA, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Bondarenko IZ, Gomova IS, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Mkrtumyan AM, Petunina NA, Ruyatkina LA, Suplotova LA, Ushakova OV, Khalimov YS. Diabetes mellitus type 2 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | | | | |
Collapse
|
8
|
Sun Y, Wang J, Li H, Sun X, Su X, Ma J. Comparison of glucose variability in patients with type 2 diabetes administrated glargine with needle-free jet injector and conventional insulin pen. Expert Opin Drug Deliv 2020; 17:713-717. [PMID: 32141347 DOI: 10.1080/17425247.2020.1738381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The effects of insulin delivered by needle-free jet injector on glycemic variations (GV) in patients with type 2 diabetes (T2D) which remains largely unknown.Research design and methods: We aimed to compare the glucose variability in Chinese T2D patients administrated glargine 100 U/mL (Gla-100) with a needle-free jet injector and conventional insulin pen. This was a self-comparative, observational study of 26 patients who were subjected to a flash glucose monitoring system (FGM) for 14 consecutive days. During the study period, all subjects received Gla-100 daily before breakfast using a conventional insulin pen, with the exception of day 3 and day 7, when insulin was delivered by needle-free jet injection. We analyzed FGM data of day 3, day 5, day 7, and day 9 at the endpoint.Results: There were no differences in the glycemic variability between the jet injector group and the conventional pen group. However, patients with needle-free jet injection had a lower 24 hr mean glucose (MG) and lower incremental area under the curve (AUC) of 1 hr, 12 hr, and 24 hr, compared to the conventional pen group (p = 0.001).Conclusions: Gla-100 delivered by needle-free jet injection potentially lowered MG in patients with T2D in the Chinese population.
Collapse
Affiliation(s)
- Yixuan Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jian Wang
- Department of Intensive Care Unit, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Huiqin Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaojuan Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
9
|
Hirsch LJ, Strauss KW. The Injection Technique Factor: What You Don't Know or Teach Can Make a Difference. Clin Diabetes 2019; 37:227-233. [PMID: 31371853 PMCID: PMC6640874 DOI: 10.2337/cd18-0076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IN BRIEF To be consistently effective, insulin must be delivered into subcutaneous tissue. If insulin is delivered intramuscularly, its uptake and action become variably faster, leading to suboptimal, inconsistent glucose control. The best strategy to avoid intramuscular injection is to use the shortest needles available. Injection sites should be rotated systematically to prevent lipohypertrophy, which also substantially affects insulin uptake and action. New evidence-based insulin delivery recommendations are available, and awareness of them should lead to more effective use of insulin therapy, improved clinical outcomes, and considerable cost savings.
Collapse
|
10
|
Zhang Y, Yu J, Kahkoska AR, Wang J, Buse JB, Gu Z. Advances in transdermal insulin delivery. Adv Drug Deliv Rev 2019; 139:51-70. [PMID: 30528729 PMCID: PMC6556146 DOI: 10.1016/j.addr.2018.12.006] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/06/2018] [Accepted: 12/05/2018] [Indexed: 12/13/2022]
Abstract
Insulin therapy is necessary to regulate blood glucose levels for people with type 1 diabetes and commonly used in advanced type 2 diabetes. Although subcutaneous insulin administration via hypodermic injection or pump-mediated infusion is the standard route of insulin delivery, it may be associated with pain, needle phobia, and decreased adherence, as well as the risk of infection. Therefore, transdermal insulin delivery has been widely investigated as an attractive alternative to subcutaneous approaches for diabetes management in recent years. Transdermal systems designed to prevent insulin degradation and offer controlled, sustained release of insulin may be desirable for patients and lead to increased adherence and glycemic outcomes. A challenge for transdermal insulin delivery is the inefficient passive insulin absorption through the skin due to the large molecular weight of the protein drug. In this review, we focus on the different transdermal insulin delivery techniques and their respective advantages and limitations, including chemical enhancers-promoted, electrically enhanced, mechanical force-triggered, and microneedle-assisted methods.
Collapse
Affiliation(s)
- Yuqi Zhang
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - Jicheng Yu
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - Anna R Kahkoska
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Jinqiang Wang
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA
| | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Zhen Gu
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC 27695, USA; California NanoSystems Institute, Jonsson Comprehensive Cancer Center, Center for Minimally Invasive Therapeutics, University of California, Los Angeles, CA 90095, USA.
| |
Collapse
|
11
|
MacMaster HW, Gonzalez S, Maruoka A, San Luis C, Stannard D, Rushakoff JA, Rushakoff RJ. Development and Implementation of a Subcutaneous Insulin Pen Label Bar Code Scanning Protocol to Prevent Wrong-Patient Insulin Pen Errors. Jt Comm J Qual Patient Saf 2018; 45:380-386. [PMID: 30266247 DOI: 10.1016/j.jcjq.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 12/25/2022]
Abstract
PROBLEM DEFINITION Insulin, a high-alert medication, is regularly prescribed in the inpatient setting for hyperglycemia and diabetes mellitus. Although convenient, insulin pens carry a risk of blood-borne pathogens if the same pen is used on multiple patients. At the University of California, San Francisco (UCSF), a new nursing protocol for insulin pen administration was developed to ensure that insulin was quickly available and to identify and move to eliminate wrong-patient insulin pen errors. This protocol involved unit-based automated dispensing machines and an electronic health record (EHR)-integrated patient-specific bar code label work flow. APPROACH After piloting on three hospital units, this new patient-specific bar code label process was expanded hospitalwide. "Print Label For Insulin Pen" and "Scan Insulin Pen" buttons were programmed into the EHR to enable nurses to print patient-specific bar code labels. In addition, a "wrong-patient pen alert" was activated to prevent wrong-pen insulin pen administration. OUTCOMES For the 162,075 inpatient insulin pen administrations during the study period (April 2017-March 2018), monthly errors (rates) ranged from 13 (0.12%) to 36 (0.23%). In total, 296 near-miss events (0.18% of all insulin pen administrations) were observed and prevented. CONCLUSION Insulin pen work flow and EHR changes implemented at UCSF enable subcutaneous insulin to remain a time-critical medication and ensure patient safety. The wide adoption of EHRs offers an opportunity to integrate patient safety improvements directly into the electronic medication administration record systems to maximize patient safety.
Collapse
Affiliation(s)
- Heidemarie Windham MacMaster
- is Diabetes Management Specialist, Institute for Nursing Excellence, University of California, San Francisco (UCSF)
| | - Sabina Gonzalez
- is Adult Critical Care Clinical Nurse Educator, Institute for Nursing Excellence, University of California, San Francisco (UCSF)
| | - Andrew Maruoka
- is Director of Clinical Documentation, APeX/EPIC Clinical Systems Department, UCSF
| | - Craig San Luis
- is Programmer, APeX/EPIC Clinical Systems Department, UCSF
| | - Daphne Stannard
- is Chief Nursing Researcher and Director, Institute for Nursing Excellence
| | | | - Robert J Rushakoff
- is Professor, Division of Endocrinology and Metabolism, UCSF, and Medical Director, Inpatient Diabetes, UCSF Medical Center.
| |
Collapse
|
12
|
Tandon N, Kalra S, Balhara YPS, Baruah MP, Chadha M, Chandalia HB, Prasanna Kumar KM, Madhu SV, Mithal A, Sahay R, Shukla R, Sundaram A, Unnikrishnan AG, Saboo B, Gupta V, Chowdhury S, Kesavadev J, Wangnoo SK. Forum for Injection Technique and Therapy Expert Recommendations, India: The Indian Recommendations for Best Practice in Insulin Injection Technique, 2017. Indian J Endocrinol Metab 2017; 21:600-617. [PMID: 28670547 PMCID: PMC5477451 DOI: 10.4103/ijem.ijem_97_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD.
Collapse
Affiliation(s)
- Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Center (Unit of Excel Care Hospitals), Guwahati, Assam, India
| | - Manoj Chadha
- Department of Endocrinology, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Hemraj B. Chandalia
- Department of Endocrinology, Diabetes Endocrinology Nutrition Management and Research Centre, Mumbai, Maharashtra, India
| | - K. M. Prasanna Kumar
- Department of Endocrinology and Metabolism, M S Ramaiah Medical College, CEO-Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| | - S. V. Madhu
- Department of Medicine, Division of Endocrinology and Metabolism, University College of Medical Sciences, New Delhi, India
| | - Ambrish Mithal
- Department of Endocrinology, Medanta Medicity, Gurugram, Haryana, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Osmania General Hospital, Hyderabad, Telangana, India
| | - Rishi Shukla
- Department of Endocrinology, Regency Hospital, Private Ltd. and Centre for Diabetes and Endocrinology, Kanpur, Uttar Pradesh, India
| | - Annamalai Sundaram
- Department of Endocrinology, Ambedkar Institute of Diabetes, Government Kilpauk Medical College, Chennai, Tamil Nadu, India
| | - Ambika G. Unnikrishnan
- Department of Clinical Diabetology and Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Banshi Saboo
- Diabetologist and Endocrine and Metabolic Physician, Diacare-Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | | | - Subhankar Chowdhury
- Department of Endocrinology, IPGME & R and SSKM Hospital, Kolkata, West Bengal, India
| | - Jothydev Kesavadev
- Jothydev's Diabetes and Reserarch Center, Thiruvananthapuram, Kerala, India
| | - Subhash K. Wangnoo
- Apollo Centre for Obesity, Diabetes and Endocrinology, Indraprastha Apollo Hospital, New Delhi, India
| |
Collapse
|
13
|
Trimble AN, Bishop B, Rampe N. Medication errors associated with transition from insulin pens to insulin vials. Am J Health Syst Pharm 2017; 74:70-75. [DOI: 10.2146/ajhp150726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
14
|
Guo L, Xiao X, Sun X, Qi C. Comparison of jet injector and insulin pen in controlling plasma glucose and insulin concentrations in type 2 diabetic patients. Medicine (Baltimore) 2017; 96:e5482. [PMID: 28072690 PMCID: PMC5228650 DOI: 10.1097/md.0000000000005482] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study is conducted to investigate efficacy of an insulin jet injector and an insulin pen in treatment of type 2 diabetic patients. Sixty patients with type 2 diabetes were treated with rapid-acting insulin (regular insulin) and insulin analog (insulin aspart) using the jet injector and the pen in 4 successive test cycles. Postprandial glucose and insulin concentrations in blood were measured over time. Areas under curves of glucose and the insulin were calculated, and efficacy of 2 injection methods in treatment of the diabetes was compared. Regular insulin and insulin aspart administration by the jet injector showed significant decreases in plasma glucose levels as compared to the pen injection (P < 0.05). Postprandial plasma glucose excursions at the time points of 0.5 to 3 hours were obviously lower in the jet-treated patients than the pen-treated ones (P < 0.05). Postprandial plasma insulin levels were markedly higher in the jet-treated patients than the pen-treated ones (P < 0.05). Area under the glucose curve in the pen-treated patients was significantly increased as compared to the jet-treated ones (P < 0.01). Efficacy of the insulin jet injector in treatment of type 2 diabetic patients is obviously superior to the insulin pen in regulating plasma glucose and insulin levels.
Collapse
Affiliation(s)
- Lixin Guo
- Department of Endocrinology, Beijing Hospital
| | - Xinhua Xiao
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Xue Sun
- Department of Endocrinology, Beijing Hospital
| | - Cuijuan Qi
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
15
|
Brown KE, Hertig JB. Determining Current Insulin Pen Use Practices and Errors in the Inpatient Setting. Jt Comm J Qual Patient Saf 2016; 42:568-AP7. [PMID: 28334561 DOI: 10.1016/s1553-7250(16)30109-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The use of insulin pens in the inpatient setting has continued to be a controversial decision. Insulin pens provide several advantages, but given significant reports of medication errors, several organizations have issued alerts to caution users about safety concerns. A survey was conducted to assess the prevalence of insulin pen use and current utilization trends in the inpatient setting. METHODS The 31-question guided-logic survey was developed based on review of primary literature regarding insulin pen utilization and evaluated by a panel of medication safety experts from a variety of health care settings. The survey was sent electronically to subscribers of medication safety organizations. RESULTS The survey was completed by 474 respondents. Approximately three fourths of respondents indicated insulin pens were on formulary at their institution (n = 332; 74%). Of those who have had insulin pens on formulary, 15% (n = 49) are no longer using them. The most common reasons for not utilizing pens were cost and safety concerns. Pens were reported to be stored in the pharmacy prior to administration (n = 230; 78%) and in a patient's bin (n = 202; 69%) afterward. More than half of respondents use two patient identifiers on the pen and label with a bar code. Approximately 30% reported that an insulin pen has been used on more than one patient at least once in their institution, while 6% were not sure. CONCLUSION Insulin pens are widely being used in the inpatient setting. Various mitigation strategies are employed to reduce the risk of harm associated with insulin pen use. Health care professionals believe insulin pens are clinically useful and can be used safely in the inpatient setting. Many organizations and expert panels disseminate best practices in an effort to help ensure their safety. Further studies are needed to assess and validate the risk mitigation strategies identified through this research.
Collapse
Affiliation(s)
- Katelyn E Brown
- Formerly Regulatory Pharmaceutical Fellow in Medication Safety, Purdue University, Indianapolis; Therapeutic Consultant for Diabetes in US Health Outcomes, Eli Lilly and Company, Indianapolis.
| | - John B Hertig
- Associate Director, Center for Medication Safety Advancement; Courtesy Clinical Assistant Professor of Pharmacy Practice, Purdue University, Indianapolis; Member, Editorial Advisory Board, The Joint Commission Journal on Quality and Patient Safety
| |
Collapse
|
16
|
Haines ST, Miklich MA, Rochester-Eyeguokan C. Best practices for safe use of insulin pen devices in hospitals: Recommendations from an expert panel Delphi consensus process. Am J Health Syst Pharm 2016; 73:S4-S16. [DOI: 10.2146/ajhp160416] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Stuart T. Haines
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS
| | - Margaret A. Miklich
- Center for Innovative Pharmacy Solutions, University of Maryland School of Pharmacy, Baltimore, MD
| | | |
Collapse
|
17
|
Lutz MF, Haines ST, Lesch CA, Szumita PM. Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program. Am J Health Syst Pharm 2016; 73:S17-31. [PMID: 27647095 DOI: 10.2146/ajhp160417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of the MENTORED QUALITY IMPROVEMENT IMPACT PROGRAM℠ (MQIIP) on Ensuring Insulin Pen Safety in Hospitals, which was part of an ASHP educational initiative aimed at ensuring the safe use of insulin pens in hospitals, are described. METHODS During this ASHP initiative, which also included continuing-education activities and Web-based resources, distance mentoring by pharmacists with expertise in the safe use of insulin pens was provided to interprofessional teams at 14 hospitals between September 2014 and May 2015. The results of baseline assessments of nursing staff knowledge of insulin pen use, insulin pen storage and labeling audits, and insulin pen injection observations conducted in September and October 2014 were the basis for insulin pen quality-improvement plans. Postintervention data were collected in April and May 2015. RESULTS Compared with the baseline period, significant improvements in nurses' knowledge of insulin pen use, insulin pen labeling and storage, and insulin pen administration were observed in the postintervention period despite the relatively short time frame for implementation of quality-improvement plans. Program participants are committed to sustaining and building on improvements achieved during the program. The outcome measures described in this report could be adapted by other health systems to identify opportunities to improve the safety of insulin pen use. CONCLUSION Focused attention on insulin pen safety through an interprofessional team approach during the MQIIP enabled participating sites to detect potential safety issues based on collected data, develop targeted process changes, document improvements, and identify areas requiring further intervention. A sustained organizational commitment is required to ensure the safe use of insulin pen devices in hospitals.
Collapse
|
18
|
Rosenberg AF. Participation in a mentored quality-improvement program for insulin pen safety: Opportunity to augment internal evaluation and share with peers. Am J Health Syst Pharm 2016; 73:S32-7. [PMID: 27647097 DOI: 10.2146/ajhp160418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE UF Health's participation in a mentored quality-improvement impact program for health professionals as part of an ASHP initiative-"Strategies for Ensuring the Safe Use of Insulin Pens in the Hospital"-is described. SUMMARY ASHP invited hospitals to participate in its initiative at a time when UF Health was evaluating the risks and benefits of insulin pen use due to external reports of safety concerns and making a commitment to continue insulin pen use and optimize safeguards. Improvement opportunities in insulin pen best practices and staff education on insulin pen preparation and injection technique were identified and implemented. The storage of insulin pens for patients with contact isolation precautions was identified as a problem in certain patient care areas, and a practical solution was devised. Other process improvements included implementation of barcode medication administration, with scanning of insulin pens designated for specific patients to avoid inadvertent and intentional sharing of pens among multiple patients. Mentored calls with teams at other hospitals conducted as part of the program provided the opportunity to share experiences and solutions to improve insulin pen use. CONCLUSION Participating with a knowledgeable mentor and other hospital teams struggling with the same issues and concerns related to safe insulin pen use facilitated problem solving. Discussing challenges and sharing ideas for solutions to safety concerns with other hospitals identified new process enhancements, which have the potential to improve the safety of insulin pen use at UF Health.
Collapse
|
19
|
Frid AH, Kreugel G, Grassi G, Halimi S, Hicks D, Hirsch LJ, Smith MJ, Wellhoener R, Bode BW, Hirsch IB, Kalra S, Ji L, Strauss KW. New Insulin Delivery Recommendations. Mayo Clin Proc 2016; 91:1231-55. [PMID: 27594187 DOI: 10.1016/j.mayocp.2016.06.010] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/15/2016] [Accepted: 06/22/2016] [Indexed: 12/14/2022]
Abstract
Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes.
Collapse
Affiliation(s)
- Anders H Frid
- Department of Endocrinology, Skane University Hospital, Malmö, Sweden
| | - Gillian Kreugel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Giorgio Grassi
- Città della Salute e della Scienza Torino, Torino, Italy
| | - Serge Halimi
- University for Sciences and Medicine Joseph Fourier Grenoble and Diabetology Department CHU Grenoble, Grenoble Cedex, France
| | - Debbie Hicks
- Barnet, Enfield & Haringey Mental Health Trust, London, UK
| | | | | | | | | | - Irl B Hirsch
- University of Washington Medical Center-Roosevelt, Seattle
| | | | - Linong Ji
- Peking University Peoples Hospital, Beijing, China
| | | |
Collapse
|
20
|
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
|
21
|
Horne J, Bond R, Sarangarm P. Comparison of Inpatient Glycemic Control with Insulin Vials Versus Insulin Pens in General Medicine Patients. Hosp Pharm 2015; 50:514-21. [PMID: 26405343 DOI: 10.1310/hpj5006-514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The Institute for Safe Medication Practices has recommended against routine use of insulin pen devices for inpatients, but the quality of inpatient glycemic control that is achieved with insulin pens versus insulin vials and syringes has not been compared. OBJECTIVE To evaluate the quality of glycemic control achieved with insulin vials versus insulin pens in type 2 diabetic general medicine patients. METHODS This retrospective cohort study compared glycemic control between 2 groups of patients on rapid-acting insulin protocols: those receiving insulin via patient-specific pen devices and those receiving insulin from patient-specific vials. Patients on a prespecified subacute care floor with a diagnosis of type 2 diabetes and at least 24 hours of glucose monitoring while on an insulin protocol with insulin lispro were included. Glycemic control was compared by area under the curve (AUC) estimations of average overall glucose and average glucose above, below, and within goal range (70-180 mg/dL). Percentages of time above, below, and within goal range were also compared. RESULTS The mean ± SD AUC-estimated average glucose for pens was 160 ± 39 mg/dL compared to 158 ± 45 mg/dL for vials (P = .752). The mean ± SD percentage time within goal range was 68.2% ± 28.1% in the pen group versus 69.4% ± 31.8% percent in the vial group (P = .825). No statistically significant differences were detected between those receiving pens or vials for any outcome before and after adjusting for baseline differences and significant covariates. CONCLUSION Glycemic control did not differ based on insulin delivery system.
Collapse
Affiliation(s)
- Juliann Horne
- PGY2 Pharmacy Resident, University of New Mexico College of Pharmacy , Albuquerque, New Mexico
| | - Rucha Bond
- Assistant Professor - Clinician Educator, University of New Mexico College of Pharmacy , Albuquerque, New Mexico
| | - Preeyaporn Sarangarm
- ED/ICU Clinical Pharmacy Lead, University of New Mexico Hospitals , Albuquerque, New Mexico
| |
Collapse
|
22
|
Reuse of insulin pens among multiple patients at 2 Veterans Affairs medical centers. Infect Control Hosp Epidemiol 2015. [PMID: 26198627 DOI: 10.1017/ice.2015.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether reuse of insulin pens among multiple patients resulted in transmission of bloodborne pathogens (BBP). DESIGN Retrospective cohort study. SETTING Two Veterans Affairs medical centers. PATIENTS Veterans who received insulin via insulin pens from 2010 to 2013. METHODS Patients were identified through electronic health records, notified of possible exposure, and serotested for human immunodeficiency virus, hepatitis C virus (HCV), and hepatitis B virus. Newly discovered case patients were assessed in relation to potential proximate patients to determine viral strain relatedness by HCV envelope (env) gene sequencing. RESULTS Of 1,791 hospitalized veterans who received insulin via insulin pen, 1,155 were tested for at least 1 viral infection after exposure. Of these, 67 patients were newly diagnosed with 1 or more viral BBPs. For human immunodeficiency virus and hepatitis B virus no additional strain testing of case or proximate patients was possible; 8 HCV cases and 45 proximates (40 unique patients; 5 patients were positive for 2 genotypes) were identified as needing strain testing. Only 3 cases and their 19 proximates had samples available for further testing. None of the 26 remaining proximate patients had blood available for further testing. Median genetic distance between the HCV env sequences of those available for additional testing ranged from 14% to 24%, indicating nonrelatedness. CONCLUSIONS Our investigation revealed that exposure to insulin pen reuse did not result in HCV transmission among patients who had viral genetic analysis performed. Analysis for any additional potential transmission of blood-borne pathogens was limited by the available samples.
Collapse
|
23
|
Paparella SF. Insulin Pens: Single Patient Use Is Mandatory for Safety. J Emerg Nurs 2015; 41:340-2. [DOI: 10.1016/j.jen.2015.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
|
24
|
Grissinger M, Gaunt MJ. Reducing harm in patients using insulin. THE CONSULTANT PHARMACIST : THE JOURNAL OF THE AMERICAN SOCIETY OF CONSULTANT PHARMACISTS 2014; 29:290-302. [PMID: 24849687 DOI: 10.4140/tcp.n.2014.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Controlling blood sugars with insulin is an important part of managing hyperglycemia in diabetic patients. However, the literature has shown that the use of insulin has been associated with more medication errors than any other type or class of drug. This article will highlight medication errors that may arise during the use of insulin in the long-term facility and provide risk-reduction recommendations to address the potential for error and patient harm.
Collapse
Affiliation(s)
| | - Michael J Gaunt
- ISMP Medication Safety Alert!® Community/Ambulatory Care Edition, Institute for Safe Medication Practices
| |
Collapse
|
25
|
|
26
|
Herdman ML, Larck C, Schliesser SH, Jelic TM. Biological contamination of insulin pens in a hospital setting. Am J Health Syst Pharm 2013; 70:1244-8. [DOI: 10.2146/ajhp120728] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Michelle L. Herdman
- Department of Pharmaceutical and Administrative Sciences, School of Pharmacy, University of Charleston, Charleston, WV
| | - Chris Larck
- Edwards Comprehensive Cancer Center, Huntington, WV
| | - Shelley Hoppe Schliesser
- School of Pharmacy, University of Charleston, and Drug Information Specialist, Charleston Area Medical Center (CAMC), Charleston
| | | |
Collapse
|
27
|
Kirkman MS, Schaffner W. Another shot to protect people with diabetes: add hepatitis B vaccination to the checklist. Diabetes Care 2012; 35:941-2. [PMID: 22517936 PMCID: PMC3329847 DOI: 10.2337/dc12-0164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M. Sue Kirkman
- From Medical Affairs and Community Information, American Diabetes Association, Alexandria, Virginia; and the
| | - William Schaffner
- National Foundation for Infectious Diseases, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
28
|
WISE recommendations to ensure the safety of injections in diabetes. DIABETES & METABOLISM 2012; 38 Suppl 1:S2-8. [DOI: 10.1016/s1262-3636(12)70975-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
29
|
US outbreak investigations highlight the need for safe injection practices and basic infection control. Clin Liver Dis 2010; 14:137-51; x. [PMID: 20123446 DOI: 10.1016/j.cld.2009.11.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Current understanding of viral hepatitis transmission in United States health care settings indicates progress over the past several decades with respect to the risks from transfusions or blood products. Likewise, risks to health care providers from sharps injuries and other blood and body fluid exposures have been reduced as a consequence of widespread hepatitis B vaccination and the adoption of safer work practices. Increasing recognition of outbreaks involving patient-to-patient spread of hepatitis B and hepatitis C virus infections, however, has uncovered a disturbing trend. This article highlights the importance of basic infection control and the need for increased awareness of safe injection practices.
Collapse
|
30
|
Cohen MR. Revatio = Sildenafil = Viagra Vital Initiative by the Institute for Safe Medication Practices Can Keep Patients Safe Lyrica-Lopressor Mix-up Cell Phones and E-mail Could Prevent Harm Reuse of Insulin Pen for Multiple Patients Risks Transmission of Blood-Borne Disease. Hosp Pharm 2009. [DOI: 10.1310/hpj4405-374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
Collapse
Affiliation(s)
- Michael R. Cohen
- Institute for Safe Medication Practices, 200 Lakeside Drive, Suite 200, Horsham, PA 19044
| |
Collapse
|
31
|
Cohen MR. Cross Contamination with Insulin Pens; Look-Alike Vials; Kids and Medication Patches; New Look-Alike Name Pair; Preventing Dosing Errors with Methotrexate Injection. Hosp Pharm 2008. [DOI: 10.1310/hpj4306-445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael R. Cohen
- Institute for Safe Medication Practices, 1800 Byberry Road, Suite 810, Huntingdon Valley, PA 19006
| |
Collapse
|
32
|
Pellissier G, Miguéres B, Tarantola A, Abiteboul D, Lolom I, Bouvet E. Risk of needlestick injuries by injection pens. J Hosp Infect 2006; 63:60-4. [PMID: 16540200 DOI: 10.1016/j.jhin.2005.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Accepted: 12/06/2005] [Indexed: 12/17/2022]
Abstract
Injection pens are used by patients when auto-administering medication (insulin, interferon, apokinon etc.) by the subcutaneous route. The objective of this study was to evaluate the rate of injection pen use by healthcare workers (HCWs) and the associated risk of needlestick injuries to document and compare injury rates between injection pens and subcutaneous syringes. A one-year retrospective study was conducted in 24 sentinel French public hospitals. All needlestick injuries linked to subcutaneous injection procedures, which were voluntarily reported to occupational medicine departments by HCWs between October 1999 and September 2000, were documented using a standardized questionnaire. Additional data (total number of needlestick injuries reported, number of subcutaneous injection devices purchased) were collected over the same period. A total of 144 needlestick injuries associated with subcutaneous injection were reported. The needlestick injury rate for injection pens was six times the rate for disposable syringes. Needlestick injuries with injection pens accounted for 39% of needlestick injuries linked with subcutaneous injection. In all, 60% of needlestick injuries with injection pens were related to disassembly. Injection pens are associated with needlestick injuries six times more often than syringes. Nevertheless, injection pens have been shown to improve the quality of treatment for patients and may improve treatment observance. This study points to the need for safety-engineered injection pens.
Collapse
Affiliation(s)
- G Pellissier
- Groupe d'Etude sur le Risque d'Exposition des Soignants aux agents infectieux (GERES), Faculté de Médecine X. Bichat, Paris, France.
| | | | | | | | | | | |
Collapse
|