“…In accordance with the present findings, previous studies showed insufficient knowledge about insulin pen use in patients with T2DM [ 15 , 16 , 28 ]. For example, in a recent nationwide survey in Bangladesh, Kamrul-Hasan et al (2020) [ 28 ] found high rates of pen users reusing needles (98.5%) and reusing them over 10 times (38.9%), possibly due to a lack of awareness of the possible number of injections per needle and the consequences of needle reuse. The repeated use of insulin needles can lead to distortion, bending, breakage, and complications, including pain, bruising, bleeding, infection, and lipohypertrophy [ 16 , 28 ].…”