Insulin pen devices have several advantages over the traditional vial-and-syringe method of insulin delivery, including improved patient satisfaction and adherence, greater ease of use, superior accuracy for delivering small doses of insulin, greater social acceptability, and less reported injection pain. In recent years, pens have become increasingly user-friendly, and some models are highly intuitive to use, requiring little or no instruction. Despite this progress, uptake of these devices in the United States has not matched that in many other areas of the world. There is a need for improved awareness of the current characteristics of insulin pen devices among United States health care professionals. Knowledge of the design improvements that have been incorporated into pens, both to address patient needs and as a result of the improved technology behind the device mechanics, is essential to promoting the use of insulin pen devices. This review highlights some of the practical aspects of pen use and discusses the factors to be considered when selecting among different insulin pens.

OBJECTIVE -To assess the impact of a quality improvement (QI) intervention on the quality of diabetes care at primary care clinics.RESEARCH DESIGN AND METHODS -Twelve primary care medical practices were matched by size and location and randomized to intervention or control conditions. Intervention clinic staff were trained in a seven-step QI change process to improve diabetes care. Surveys and medical record reviews of 754 patients, surveys of 329 clinic staff, interviews with clinic leaders, and analysis of training session videotapes evaluated compliance with and impact of the intervention. Mixed-model nested analyses compared differences in the quality of diabetes care before and after intervention.RESULTS -All intervention clinics completed at least six steps of the seven-step QI change process in an 18-month period and, compared with control clinics, had broader staff participation in QI activities (P ϭ 0.04), used patient registries more often (P ϭ 0.03), and had better test rates for HbA 1c (A1C), LDL, and blood pressure (P ϭ 0.02). Other processes of diabetes care were unchanged. The intervention did not improve A1C (P ϭ 0.54), LDL (P ϭ 0.46), or blood pressure (P ϭ 0.69) levels or a composite of these outcomes (P ϭ 0.35).CONCLUSIONS -This QI change process was successfully implemented but failed to improve A1C, LDL, or blood pressure levels. Data suggest that to be successful, such a QI change process should direct more attention to specific clinical actions, such as drug intensification and patient activation.

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Purpose The US health care system’s focus on high-quality, efficient, and cost-effective care has led payers and provider groups to identify new models with a shift toward value-based care. This perspective on clinical practice describes the population health movement and the opportunities for diabetes educators beyond diabetes self-management education, as well as steps to engage in and drive new care models to demonstrate individual, organizational, and payer value. Conclusion Diabetes educators have an opportunity to position themselves as diabetes specialists for diabetes management, education, and population health care delivery. With expertise that extends beyond diabetes self-management education and with a wide variety of skills, diabetes educators recognize that there is a range of personal, social, economic, and environmental factors that influence diabetes health outcomes. Diabetes educators should align with organizational strategic plans and support the population-level performance measures and quality initiatives, thus enhancing the value that diabetes educators bring to health care organizations.

Over the past 2 decades, a number of different studies have demonstrated that tight metabolic control not only reduces the incidence but also delays the development of complications in people with type 1 and type 2 diabetes. Unfortunately, the intensive insulin therapy required to achieve tight glucose control is also associated with a significantly increased risk of developing hypoglycemia. Hypoglycemia can cause physical as well as psychosocial morbidity, has been associated with adverse neurological manifestations, and can sometimes result in death. It can affect daily activities such as driving, working, and studying and can result in inconvenience and embarrassment as well as cause fear for both the person with diabetes and significant others. This fear is often the biggest barrier for optimal glycemic control. With self-management education and regular monitoring of blood glucose, people with diabetes can learn to recognize their unique signs and symptoms of hypoglycemia, and with improved understanding of how insulin, food, and activity affect blood glucose levels, the patient can learn to prevent hypoglycemia. However, because managing blood glucose can be such a delicate balancing act, it is important to be prepared. An important weapon in the treatment of severe hypoglycemia is the use of glucagon, a treatment that is generally underappreciated, underevaluated, undertaught, and most certainly underutilized. The purpose of this article is to review the role of glucagon in the treatment of severe hypoglycemia and discuss how better information about and understanding of the use of glucagon might be helpful toward alleviating some of the fears surrounding hypoglycemia.