Pen Devices for Insulin Administration Compared to Needle And Vial: Systematic Review of Literature and Meta-Analysis

Lasalvia, Pieralessandro; Barahona, J; Romero, Diana; Gil, Sergio Ramón Lorente; Castañeda‐Cardona, Camilo; Bayona, JG; Triana, JJ; Laserna, Andrés; Restrepo, Pablo Arango; Niño, Maria Claudia; Rosselli, Diego

doi:10.1016/j.jval.2015.09.709

Cited by 16 publications

(23 citation statements)

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“…Insulin pens were also unavailable for most PCPs in this survey. Insulin pens have been associated with improved adherence and better self-management while remaining cost-effective [36][37][38]. Consideration should be given to expanding the existing Trinidadian public formulary to include rapid acting insulin and insulin pen devices for the benefits presented.…”

Section: Discussionmentioning

confidence: 99%

Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study

Motilal

2020

BMC Fam Pract

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Background Physician related factors with respect to insulin therapy can contribute to diabetes mellitus (DM) mismanagement. Patient related factors have been previously explored in a Trinidad survey. The main objective of this study was to explore primary care physicians’ (PCPs) related barriers towards insulin therapy. Methods A cross-sectional study on a convenience sample of PCPs in the public primary care system was done using an online survey. Results Of the 170 PCPs contacted, 75 (44%) responded. There were 47 females (62.7%) and 28 males (37.3%) with a mean age of 35.9 yrs. Nearly 40% of physicians admitted that the education given to patients was inadequate to allow initiation of insulin therapy. Half the respondents admitted to insufficient consultation times and inadequate appointment frequency to allow for intensification of insulin therapy. Forty percent of PCPs admitted that HbA1c results were unavailable to guide their management decisions. Only 6.7% of physicians said they had access to rapid acting insulin, while 5.3% said they had access to insulin pens. Conclusion PCPs in Trinidad treating diabetes at the public primary care clinics face several barriers in administering proper insulin therapy. Addressing these factors can improve glycemic control in this population.

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Section: Discussionmentioning

confidence: 99%

Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study

Motilal

2020

BMC Fam Pract

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“…It also showed a trend in favor of pen devices in the percentage of people who reached HbA1c <7% without significant heterogeneity. 32 The 17 studies that contributed to this meta-analysis together showed a clear long-term trend of fewer hypoglycemic events with pen device use, as compared with syringes. Although the link between dose accuracy of insulin pen devices and clinical outcomes is not strongly established in clinical studies, the higher accuracy of the dose delivered by pen devices may enable better glycemic control and a lower rate of hypoglycemia.…”

Section: Hba1c and Hypoglycemiamentioning

confidence: 92%

Precision Dosing of Rapid-Acting Insulin Matters

Aanstoot¹,

Rodriguez

Weinzimer

et al. 2020

Diabetes Technology & Therapeutics

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Despite several molecular and technological advances in insulin therapy and insulin delivery, global evidence highlights inadequate glycemic control in populations with type 1 diabetes (T1D) and type 2 diabetes (T2D). In this review, we discuss the importance of more precise dosing of insulin as one of the approaches to improve glycemic control while reducing hypoglycemic events. This report is based on the expert opinion of authors and literature search of articles relevant to the past and present insulin delivery devices in diabetes management, especially half-unit insulin pens. We describe the various factors that facilitate better glycemic control, focusing on the impact of appropriate insulin delivery device selection on diabetes management. Precision dosing of insulin is a lesser-studied factor that contributes toward better glycemic control. Insulin pens have consistently outperformed syringes as delivery devices due to their greater accuracy and precision of dosing, ease-of-use, and patient preference. These advantages make them better suited to administer insulin in hypoglycemia-prone insulin-sensitive people with T1D, particularly younger children and geriatric patients. Half-unit insulin pens further extend this benefit by delivering half-unit doses of insulin accurately. They may contribute to better management of diabetes by allowing flexible dosing for mealtimes and physical activities even in erratic diet situations or illnesses by offering corrective doses in small increments. They are ideal delivery devices for insulin-sensitive people with T1D who require greater accuracy and precision in insulin delivery to achieve more stringent glycemic control.

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“…Of note, all reviewed articles were assessed as having some risk of bias, largely due to the lack of masking and insufficient explanation of randomization methods. 21 Several new insulin ''smartpen'' systems integrate the standard insulin pen with additional features. The Eli Lilly Memoir insulin pen was one of the first to track administered doses and can store the last 16 doses administered.…”

Section: Insulin Delivery Devicesmentioning

confidence: 99%