Do Diabetic Patients Inject Accurate Doses of Insulin?

Kesson, C. M.; Bailie, George R.

doi:10.2337/diacare.4.2.333a

Cited by 40 publications

(17 citation statements)

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“…Studies have shown that the insulin doses of elderly people who self-inject can have an approximately 12.2-19% error rate. 7,8 In comparison with the syringe and vial, pen devices have been demonstrated to be safe, and patients have expressed a preference for using them. 9 In another study, pen devices were shown to be safe among patients older than 60 years old who were using a syringe and vial previously to self-administer insulin; 90% of these patients preferred using the pen device.…”

Section: Introductionmentioning

confidence: 98%

A Comparison of the Handling and Accuracy of Syringe and Vial Versus Prefilled Insulin Pen (FlexPen)

Asakura

Seino

Nakano³

et al. 2009

Diabetes Technology & Therapeutics

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Section: Introductionmentioning

confidence: 98%

A Comparison of the Handling and Accuracy of Syringe and Vial Versus Prefilled Insulin Pen (FlexPen)

Asakura

Seino

Nakano³

et al. 2009

Diabetes Technology & Therapeutics

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“…8 Furthermore, it has been estimated that 12-19% of prescribed insulin is lost due to wastage in syringe fillings and errors with drawing dosages. 9 However, this estimate may not apply to all patients, in particular, not to those using modern insulin pens. Most user of insulin pens carry out priming and safety shots with pens, which may take 6 to 8 IU for priming when a new pen is used and about 1 to 2 IU for safety shots before each injection, which is another potential explanation for the difference of CDD and PDD.…”

Section: Discussionmentioning

confidence: 99%

Calculated Daily Insulin Dosages Overestimate Prescribed Insulin Doses in Type 2 Diabetes: A Primary Care Database Study

Kostev

Rathmann

2016

J Diabetes Sci Technol

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Background:The aim was to compare the prescribed and calculated daily insulin dosages based on prescription data in type 2 diabetes patients in a general practice database. Methods:A total of 17 782 type 2 diabetes patients (age: 70.0 ± 11.5 years; 52% males; 16% diabetologist care) with ≥2 insulin prescriptions from 834 practices were analyzed (Disease Analyser: 01/2011-12/2015. Prescribed daily dosage (PDD) (physician documentation) and calculated daily dose (CDD) (pack size × strength × volume / days between 2 prescriptions) were calculated for short-acting, long-acting, and premixed insulins. PDD and CDD were compared using paired t-tests. Linear regression models assessed the associations of insulin dosage difference (CDD-PDD) with age, sex, diabetologist care, private health insurance, obesity, HbA1c, hypertension, hyperlipidemia, macro-and microvascular complications. Results: Mean [SD] CDDs were higher than PDDs for short-acting (52 [28] vs 48 [26] units/day), long-acting (30 [20] vs 24 [15] units/day), and premixed (46 [26] vs 40 [21] units/day) insulins (all P < .05). In regression models, age (per year) was associated with higher CDD-PDD differences (+0.11, +0.04, +0.10; P < .01) for short-, long-acting, and premixed insulins, respectively. Diabetologist care was related to lower differences (-2.92, -1.02, -3.65; all P < .05). HbA1c was associated with higher differences in long-acting and premixed insulins, but was related to a lower difference in short-acting insulins (all P < .05).Conclusions: CDD in primary care database studies substantially overestimate the PDD (8-25%). Age, diabetologist care, and glycemic control were related to CDD-PDD differences. Priming and safety shots with pens, dosing errors, or the accumulation of insulin reserves by patients may be underlying reasons.

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“…Dosing errors with injectable agents such as insulin or exenatide once weekly can result in inadequate glycemic control or hypoglycemia in the event of overdose. 17,18 Pen injectors have helped greatly to 19,20 However, multidose pen injectors could introduce dosing errors if the dose is incorrectly dialed or if the dose display is misread. 21 The single-use dual-chamber pen allows for the delivery of only 1 dose with no titration and mitigates concerns of overdose.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Dual-Chamber Pen Design for the Injection of Exenatide Once Weekly for the Treatment of Type 2 Diabetes

LaRue

Malloy

2015

J Diabetes Sci Technol

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Exenatide is the first-in-class glucagon-like peptide-1 receptor agonist (GLP-1RA) originally approved in 2005 by the US Food and Drug Administration (FDA) as a twice daily premeal subcutaneous injection administered by pen for the treatment of hyperglycemia in patients with type 2 diabetes mellitus (T2DM).1 GLP-1RAs increase glucose-dependent insulin secretion, suppress glucagon secretion, and slow gastric emptying.2 The exenatide molecule shares approximately 53% structural similarity to human GLP-1 but is resistant to enzymatic degradation by dipeptidyl peptidase-4 resulting in a prolonged physiological response and an increased halflife of 2.4 hours compared with 2 minutes for native GLP-1. [1][2][3] In 2012, the US FDA approved a long-acting formulation of exenatide for once-weekly administration that can be administered regardless of meal times; 4 European Medicines Agency approval occurred in 2011. The long-acting, sustained release of exenatide is achieved by dispersion of the parent exenatide molecule in poly-(D,L-lactide-co-glycolide) polymer microspheres approximately 0.06 mm in diameter. Similar polymer material has been used in surgical sutures, bone plates, and orthopedic implants for decades. 5These exenatide-containing microspheres must be suspended Methods: Design development goals were established, and validation tests (dose accuracy, torque/force requirements, usability, and ease-of-use) were performed. Dose accuracy was tested under a variety of conditions. After 10 exploratory studies in 329 patients, the final design's usability and ease-of-use were tested in untrained health care practitioners (HCPs; n = 16) and untrained/trained patients (n = 30/17). Usability testing evaluated completion of multiple setup, dose preparation, and injection steps. Ease-of-use impression was assessed using a scale of 1−7 (1 = very difficult, 7 = very easy). Results:The dual-chamber pen successfully met development goals and delivered target volume (650 µL ± 10%) under tested conditions (mean 644.7-649.3 µL), with torque and force requirements below prespecified maximum values. In the final user study, most participants (≥87%) correctly completed pen setup, dose preparation, and injection steps. Mean easeof-use scores were 5.8, 6.3, and 6.5 out of 7 in untrained HCPs, untrained patients, and trained patients, respectively. Conclusion:With self-education or minimal training, participants accurately and precisely suspended, mixed, and delivered exenatide-containing microspheres using the dual-chamber pen with high ease-of-use scores. The dual-chamber pen was FDA-approved in February 2014.

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Do Diabetic Patients Inject Accurate Doses of Insulin?

Cited by 40 publications

References 0 publications

A Comparison of the Handling and Accuracy of Syringe and Vial Versus Prefilled Insulin Pen (FlexPen)

A Comparison of the Handling and Accuracy of Syringe and Vial Versus Prefilled Insulin Pen (FlexPen)

Calculated Daily Insulin Dosages Overestimate Prescribed Insulin Doses in Type 2 Diabetes: A Primary Care Database Study

Evaluation of the Dual-Chamber Pen Design for the Injection of Exenatide Once Weekly for the Treatment of Type 2 Diabetes

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