International injection recommendations for patients with diabetes have recently been published and have identified specific recommendations for health care professionals. This article provides an evidence-based translational and practical review of the research regarding injection technique and teaching/learning theory. Diabetes educators need to reevaluate how they provide instruction for the administration of insulin and other injectable medications. Research regarding skin and subcutaneous thickness reveals that shorter needles may be appropriate for the majority of patients regardless of body mass index. Periodic reassessment of injection technique, including suspension of cloudy insulins and inspection of injection sites for lipohypertrophy, is a critical aspect of the role of the diabetes educator. An injection checklist is provided as a guide for diabetes educators.

ObjectiveThe goal of this study was to describe medication usage patterns in patients with type 2 diabetes mellitus (T2DM) initiating treatment with non-insulin antidiabetic drugs (NIADs), basal insulin, or prandial/mixed insulin using real-world data.Research design and methodsA retrospective analysis using the Truven Health MarketScan Research Databases was conducted to identify adults (≥18 years) with T2DM from 2006 to 2012. Patients were categorized into four cohorts based on diabetes treatment. Cohort 1 (n=597 664) consisted of newly diagnosed patients who did not receive any treatment, cohort 2 (n=342 511) included NIAD initiators, cohort 3 (n=99 578) included basal insulin initiators, and cohort 4 (n=62 876) included prandial/mixed insulin initiators. Patients transitioned out of a cohort once they met the criteria for the next one.ResultsPatients in cohort 2 were younger (56.2 years, SD±12.1) than patients in cohorts 1, 3, and 4 (58 years, SD±0.75). Metformin was the most commonly prescribed drug in cohort 2 patients. Basal insulin usage decreased from 71% in year 1 to 47% in year 4, in cohort 3 patients. Approximately one-third of these patients switched to prandial/mixed insulin each year. In cohort 4, the usage of prandial/mixed insulin decreased to 61% by year 4. Use of basal insulin and NIAD remained common in this group. Mean glycosylated hemoglobin (HbA1c) values decreased by ∼1% for each of the treatment cohorts following treatment initiation and remained stable during follow-up. All-cause and diabetes-related medical costs were highest for patients in cohorts 3 and 4.ConclusionsOverall, our findings demonstrate that treatment intensification was low in all study cohorts despite elevated HbA1c levels during preindex and follow-up period.

To compare overall and diabetes-related health care utilization and expenditures in Medicare beneficiaries with diabetes prior to and after implementation of Part D. METHODS: Data were from the 2001-2010 Medical Expenditure Panel Survey. Medicare beneficiaries aged ≥65 years with selfreported diabetes were identified, excluding individuals who were Medicare-Medicaid dual eligible, had TRICARE, or other public coverage. The outcomes included overall and diabetes-related prescriptions, medical services utilization, and expenditures as well as out-of-pocket costs. These outcomes were analyzed using generalized linear model regression models with a log-link and gamma (for costs) or Poisson (utilization) distribution. All expenditures were inflated to 2010 dollars. STATA survey commands were used to account for the complex survey design. RESULTS: There were 21,864 eligible Medicare beneficiaries with diabetes that comprised the sample population. After adjusting for sociodemographic characteristics and health status, implementation of Part D was associated with decreased out-of-pocket expenditures for insulin (Coeff.:-0.577, p<0.05) and oral antidiabetic agents (Coeff.:-1.292, p<0.001). No statistically significant effect on total health care and prescription expenditures were found. Implementation of Part D was associated with increased number of prescriptions filled (Coeff.: 0.145, p<0.001) without increase in emergency room visits or inpatient stays. CONCLUSIONS: The implementation of Medicare Part D increased medication use and reduced out-of-pocket costs for elderly diabetes patients. This reduction would allow for enhanced access to necessary medications, and thereby may have a positive impact on adherence and health outcomes.

Insulin formulations and injection devices have improved dramatically since the first insulin injection was given in 1922. Adherence to insulin therapy, however, is estimated at 62–64 % despite research indicating that good glycemic control improves patient outcomes. The challenge is to improve the rates of adherence and to intensify or progress insulin therapy as needed. Changes in insulin delivery devices, especially innovations in needle technology in combination with education and support, have the potential to improve the comfort of insulin injections and encourage patients to adhere to their insulin regimens.