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.

Glucagon-like peptide-1 (GLP-1) receptor agonists are a relatively new therapeutic option for the treatment of type 2 diabetes mellitus (T2DM). These agents are generally well tolerated and provide glycemic control and other clinical benefits. 1,2 Aside from their efficacy in reducing glycated hemoglobin via effects on both fasting plasma glucose and postprandial plasma glucose, GLP-1 receptor agonists allow patients to achieve glycemic targets, with beneficial effects on weight being reported. 1,3-6 One of the key benefits of GLP-1 receptor agonists is that they stimulate insulin secretion and inhibit glucagon secretion in a glucose-dependent manner, and therefore carry a limited risk of hypoglycemia. 3,7 The GLP-1 receptor agonists currently available are exenatide (Byetta ® , Bristol-Myers Squibb/AstraZeneca), administered as a twice-daily injection; 8 liraglutide (Victoza ® , Novo Nordisk), administered as a once-daily injection; 9 exenatide (Bydureon ® , Bristol-Myers Squibb/AstraZeneca), administered as a once-weekly injection; and lixisenatide (Lyxumia ® , Sanofi-Aventis), a once-daily prandial GLP-1 receptor agonist. 10 Twice-daily exenatide as well as oncedaily liraglutide and once-daily lixisenatide are available as ready-to-use prefilled pen devices for subcutaneous injection. Exenatide is available in 2 different fixed-dose 511733D STXXX10.

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.

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