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Kamrul-Hasan ABM, Hannan MA, Alam MS, Rahman MM, Asaduzzaman M, Mustari M, Paul AK, Kabir ML, Chowdhury SR, Talukder SK, Sarkar S, Hannan MA, Islam MR, Iftekhar MH, Robel MAB, Selim S. Comparison of simplicity, convenience, safety, and cost-effectiveness between use of insulin pen devices and disposable plastic syringes by patients with type 2 diabetes mellitus: a cross-sectional study from Bangladesh. BMC Endocr Disord 2023; 23:37. [PMID: 36782190 PMCID: PMC9926700 DOI: 10.1186/s12902-023-01292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Insulin pen devices and disposable plastic insulin syringes are two common tools for insulin administration. This study aims to compare the simplicity, convenience, safety, and cost-effectiveness of insulin pens versus syringe devices in patients with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional study was conducted at 14 diabetes clinics throughout Bangladesh from November 2021 to April 2022 among adults with T2DM injecting insulin by pen devices or disposable insulin syringes at least once a day for at least one year by purposive sampling. The simplicity, convenience, and safety of insulin devices were assessed using a structured questionnaire, and the study subjects were scored based on their answers; higher scores indicated a poorer response. Total scores for simplicity, convenience, and safety were obtained by adding the scores for relevant components. Their average monthly medical expense and cost of insulin therapy were recorded. The median values of the total scores and monthly expenses were compared between pen devices and disposable syringe users. RESULTS 737 subjects were evaluated; 406 were pen users, and 331 were vial syringe users. The pen users had lower median scores for simplicity [6.0 (5.0-8.0) vs. 7.0 (5.0-9.0), p = 0.002], convenience [4.0 (3.0-6.0) vs. 5.0 (4.0-6.0), p < 0.001], and safety [7.0 (6.0-8.0) vs. 7.0 (6.0-9.0), p = 0.008] than vial syringe users. Pen devices were more expensive than vial syringes in terms of average medical expense per month [BDT 5000 (3500-7000) vs. 3000 (2000-5000), p < 0.001], the total cost of insulin therapy per month [BDT 2000 (1500-3000) vs. 1200 (800-1700), p < 0.001] and cost per unit of insulin used [BDT 2.08 (1.39-2.78) vs. 0.96 (0.64-1.39), p < 0.001]. Non-significant differences in favor of pens were observed in HbA1c levels [8.7 (7.8-10) vs. 8.9 (7.9-10)%, p = 0.607] and proportions of subjects having HbA1c < 7% (6.9 vs. 6.3%, p = 0.991). CONCLUSION Insulin pens are simpler, more convenient, and safe but more expensive than vial syringes. Glycemic control is comparable between pen and syringe users. Long-term follow-up studies are needed to determine the clinical and economic impacts of such benefits of insulin pens.
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Affiliation(s)
- A B M Kamrul-Hasan
- Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh.
| | | | | | | | - Md Asaduzzaman
- Department of Endocrinology, Shaheed Sheikh Abu Naser Specialized Hospital, Khulna, Bangladesh
| | - Marufa Mustari
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Ajit Kumar Paul
- Department of Endocrinology, Mainamoti Medical College, Cumilla, Bangladesh
| | - Md Lutful Kabir
- Department of Endocrinology, Rangpur Medical College, Rangpur, Bangladesh
| | - Sumon Rahman Chowdhury
- Department of Diabetes, Endocrinology and Metabolism, Chittagong Diabetic General Hospital, Chattogram, Bangladesh
| | | | - Sourav Sarkar
- Department of Medicine, Boalkhali Upazila Health Complex, Chattogram, Bangladesh
| | | | | | | | | | - Shahjada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Veasey R, Ruf CA, Bogatirsky D, Westerbacka J, Friedrichs A, Abdel-Tawab M, Adler S, Mohanasundaram S. A review of reusable insulin pens and features of TouStar-a new reusable pen with a dedicated cartridge. Diabetol Metab Syndr 2021; 13:147. [PMID: 34924015 PMCID: PMC8684684 DOI: 10.1186/s13098-021-00763-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Since the introduction of the first reusable insulin pen, the advancement in the design of these pens is still ongoing to develop a safe, more efficacious, less painful, and easy to use insulin pen device. MAIN BODY Possible errors in insulin delivery can occur at any stage of insulin delivery such as during the prescription stage, dispensing stage, or at administration stage. Mismatch of the insulin pen and cartridge is not uncommon and is a potential risk for individuals with diabetes due to serious consequences associated with incorrect insulin usage. The similarities in insulin cartridges of different manufacturers with regard to color and product names could lead to mix-up of insulin pens and cartridges. These unmet needs have led to the ongoing search for developing insulin pens that can address these errors and provide more efficacious and safer choices for patients with diabetes. CONCLUSION This review provides an overview of currently available reusable pens in the market and highlights the features of TouStar®, a new reusable pen with a dedicated cartridge intended to mitigate the risk of mismatch of the cartridge.
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Affiliation(s)
| | | | | | | | | | | | - Steffen Adler
- Dr. Arnd Friedrichs Unternehmensberatung, Görlitz, Germany
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Iacomelli I, Giulietti C, Di Bari M. Looking for a needle in a haystack: an older diabetic man with cheiroarthropathy loses an insulin pen needle in subcutaneous tissue. Aging Clin Exp Res 2021; 33:1725-1728. [PMID: 32889662 DOI: 10.1007/s40520-020-01692-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Iacopo Iacomelli
- Diabetes Clinic and Geriatric Clinic, Department of Internal and Specialist Medicine, Internal Medicine Unit, Santa Maria alla Gruccia - Valdarno Hospital, Azienda USL Toscana Sud Est, Piazza del Volontariato 2, 52025, Montevarchi, Arezzo, Italy.
| | - Chiara Giulietti
- Internal Medicine Unit, San Giuseppe Hospital, Azienda USL Toscana Centro, Empoli, Florence, Italy
| | - Mauro Di Bari
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Abstract
BACKGROUND Achieving and maintaining controlled glycemic levels are challenging in people with insulin-treated diabetes mellitus, suboptimal insulin injections being the main obstacle to treatment success. METHODS This research article presents the main functionalities and performance tests on Insulclock®, an electronic device plugged into insulin pens and connected with a smartphone app to improve insulin management. Insulclock tracks the date, time of day, dose, type of insulin, temperature, and duration of insulin injections. Information is stored in the device memory and is available for analysis by patients and health care providers. Insulclock device also has a reminder system with visual and acoustic alerts to reduce insulin omissions and mistiming. RESULTS The main performance tests reveal that Insulclock can detect seven types of insulin pens with a 97% correct classification rate. Among 556 injections, most of the doses were accurately detected (deviation = 0), with relative errors ranging from 3% to 7% across different dosages. The duration of injections recorded by this device strongly correlated with that detected by an external chronometer (R2 = 0.99, root-mean-square deviation [RMSD] = 0.39). Moreover, the precision of the temperature sensor was evidenced by high correlation of temperatures detected by Insulclock and by an external thermometer (Pearson's R2 = 0.90, RMSD = 0.45). CONCLUSIONS Insulclock is a novel device capable of tracking dosing, timing, and missing insulin injections. The promising capabilities it offers for diabetes mellitus self-management may help health care providers, researchers, and insulin users avoid frequent errors in insulin administration.
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Affiliation(s)
| | - Cristina Abreu
- 1 Endocrinology and Nutrition Unit, Segovia General Hospital, Segovia, Spain
| | | | - Luis Ruiz
- 2 Insulcloud S.L. (B87131454), Madrid, Spain
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Abstract
With the expiration of patent protection for several originator insulin analog molecules, the availability of insulin analog copies is set to increase. Many regulatory authorities have developed, and continue to refine, guidelines for the approval of biosimilar insulin analogs. Aspects such as the structure, pharmacokinetics and pharmacodynamics, efficacy, safety, and immunogenicity of biosimilar insulin analogs are extensively addressed in these guidelines, but how the biosimilar insulin analog is administered to people with diabetes is not usually a topic. The aim of this article is to highlight that the delivery device-drug combination is of particular importance. Regulatory, legal, and practical aspects of the delivery device, be it a syringe, pen, or pump, have to be considered in the context of biosimilar insulin analogs. Although the safety and efficacy of biosimilar insulin analogs per se are of primary importance for physicians and people with diabetes, functions and features of the devices used for administration also require attention from a practical point of view. Unfortunately, although there are several clinical studies investigating the technical aspects of and patient preference for the originator insulin analog pens, there are currently very little published data for nonoriginator or biosimilar insulin analog pens. In addition, it is not known if it is safe to assume that a biosimilar insulin analog cartridge is compatible with an existing originator insulin analog pen. We believe that there is a need for more discussion on the role of devices for administration of biosimilar insulin analogs.
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Affiliation(s)
| | - Ingo Fritz
- 2 Device Development, Sanofi , Frankfurt, Germany
| | - Hootan Khatami
- 3 Escala Therapeutics, a subsidiary of Fortress Biotech, New York, New York
| | - Steven V Edelman
- 4 Division of Endocrinology and Metabolism, University of California San Diego , San Diego, California
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Forough AS, Esfahani PR. Impact of Pharmacist Intervention on Appropriate Insulin Pen Use in Older Patients with Type 2 Diabetes Mellitus in a Rural Area in Iran. J Res Pharm Pract 2017; 6:114-119. [PMID: 28616435 PMCID: PMC5463546 DOI: 10.4103/jrpp.jrpp_16_151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of pharmacist-conducted educational intervention on reducing errors related to inappropriate insulin pen use. METHODS This was a prospective, before-after study with an educational intervention component. The study was conducted on 122 elderly diabetic patients. Data were collected through interviews using researcher-administered questionnaires as well as patients' medical records. Patients were asked about the preparation, injection, and storage techniques, they followed when using insulin pens. Blood glucose parameters were extracted from laboratory records. After the detection of errors, patients and their caregivers were instructed about the insulin pen use by the pharmacist. Patients were reevaluated after 12 weeks. FINDINGS Patients' mean age was 67.2 ± 3.5 with male: female ratio of 71:51. Mean diabetes duration was 7.1 ± 2.8 years. Fifty-four patients (44.2%) stated that they had received instructions for insulin pen use previously. The majority of this group (24 cases, 44.4%) reported that the instructions were given by a pharmacist. The mean number of errors decreased from 3.99 ± 0.22 errors per patient to 1.49 ± 0.13 errors (odds ratio: 0.28, 95% confidence interval: 0.23-0.33,P < 0.05). Of eleven evaluated insulin pen-related medication error items, nine items experienced a significant decrease after patient education. Fasting plasma glucose (FPG) levels decreased significantly from 161.7 ± 12.5 to 147.3 ± 13.1 mg/dL (P < 0.05). However, glycated hemoglobin levels did not change significantly after 3 months (P = 0.18). Controlled FPG had a significant rise from 45% before education to 63.9% postintervention (P < 0.05). CONCLUSION Pharmacists can play an important role in safe and efficient use of insulin pen in elderly diabetic patients by minimizing the likelihood of medication errors associated with insulin pen use.
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Affiliation(s)
- Aida Sefidani Forough
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Department of Pharmaceutical Care, Amiralmomenin Hospital, Khodabandeh, Iran
| | - Parsa Riazi Esfahani
- National Organization for Development of Exceptional Talents (NODET), Tehran, Iran
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Lee JH, Hong ES, Ohn JH, Cho YM. Is the indicator magnifying window for insulin pens helpful for elderly diabetic patients? Diabetes Metab J 2013; 37:149-51. [PMID: 23641356 PMCID: PMC3638226 DOI: 10.4093/dmj.2013.37.2.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/02/2013] [Indexed: 11/08/2022] Open
Abstract
Patients with type 2 diabetes who require insulin therapy are commonly elderly and have poor visual acuity. In this study, we examined the clinical usefulness of the indicator magnifying window (IMW) for elderly patients with type 2 diabetes. We recruited 50 patients with type 2 diabetes over the age of 60 who had used insulin pens for glucose control. They were asked to set the insulin pen at randomly selected doses with or without an IMW. We assessed dosing accuracy, convenience, self-confidence, need for eyeglasses, preference, and willingness to recommend the IMW to other patients. Although the IMW did not improve the dosing accuracy or convenience, it significantly decreased the need for eyeglasses. Overall, the clinical usefulness of the IMW is quite limited in elderly patients with type 2 diabetes.
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Affiliation(s)
- Ju Hee Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Eun Shil Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hun Ohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abul-Ainine SA, Abul-Ainine AA. Toddlers’ choice: Yo-Yoing diabetes control or deci-unit insulin dosing? World J Diabetes 2012; 3:35-7. [PMID: 22375164 PMCID: PMC3284519 DOI: 10.4239/wjd.v3.i2.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/24/2011] [Accepted: 02/08/2012] [Indexed: 02/05/2023] Open
Abstract
While the incidence of toddlers’ diabetes is soaring, their mainstay insulins were withdrawn, namely the weak 10% or 20% insulin mixtures (WIM), which were injected only once or twice daily. Consequently, toddlers are coerced to use an insulin pump, multi-dose insulin regime (MuDIR), mix or dilute insulins. This paper highlights the difficulties and proposes a simple solution. While an insulin pump is the best available option, it is not readily available for everyone. Mixing insulins is not sufficiently precise in small doses. Although diluting insulin would allow precise dosing and reduce the dose variability secondary to dribbling after injections, it, like insulin mixing, deprives children from using the pen and related child-friendly accessories. In MuDIR, we inject 4-5 small doses of insulin instead of 1-2 daily larger doses of WIM. Thus, on using a half unit (½unit) insulin pen, a dose of 0.5, 1, 1.5 and 2 units are adjusted in steps of 100%, 50%, 33% or 25%; unlike the advisable 5%-20%. This does not easily match the tiny erratic meals of grazing toddlers. Maternal anxiety peaks on watching yo-yoing glycemia. Carers have to accept either persistently high sugar or wild fluctuation. The risks of such poor glycemic pattern are increasingly recognized. Using insulin U20 in a ½unit disposable pen allows deci-unit dosing, with 5%-20% dose-tuning, greater accuracy on delivering small doses and reduction of dose variability from dribbling. Deci-unit dosing may help avoid wide glycemic swings and provide the affordable alternative to insulin pumps for toddlers. Deci-unit pen materializes the Human Rights of Children, a safer and effective treatment.
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Affiliation(s)
- Sarah Aa Abul-Ainine
- Sarah AA Abul-Ainine, Foundation Year Doctor Royal Bolton Hospital, Bolton, BL4 0JR, England, United Kingdom
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