Starting subcutaneous insulin doses in a paediatric population with newly diagnosed type 1 diabetes

Lemieux, Lisa; Crawford, Susan; Pacaud, Danièle

doi:10.1093/pch/15.6.357

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…Moreover, the daily dose of insulin needed for each person can vary greatly, depending on body weight and insulin sensitivity. 71 -74 Over the past 35 years, technological innovations have enabled the design of accurate pen injectors with small, single-use needles and low manual injection force to improve the overall injection experience for individuals, 75 with improved accuracy and reproducibility of the delivery of insulin doses, including small doses, compared with vial and syringe. 76 -79 Asakura et al 36 reported that using a pen injector was more accurate than vial and syringe regardless of HCP experience in insulin therapy.…”

Section: Factors Affecting the Performance Of Insulin Pen Injector Te...mentioning

confidence: 99%

Factors Affecting Performance of Insulin Pen Injector Technology: A Narrative Review

Sparre

Hammershøy

Steensgaard

et al. 2022

J Diabetes Sci Technol

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Background: Insulin treatment is an essential hormone replacement therapy for the survival of people with type 1 diabetes and is often used for treatment in type 2 diabetes, particularly as the disease progresses. Advances in insulin therapy have been made since its discovery, including production of human insulin and development of insulin analogs with improved efficacy and safety profiles. The different types of available insulin formulations allow health care professionals to personalize treatment to an individual’s needs. Generally, insulin requires parenteral administration via subcutaneous injection owing to very low oral bioavailability. Methods: This article reviews the human, technological, economical, and regulatory factors affecting the performance of insulin pens and the relationship between them. Opportunities and challenges that insulin pen injections may encounter in the future are also considered. Results: Insulin delivery devices, together with other factors, influence dose accuracy, convenience, and quality of life, contributing to easier medication administration with high efficacy and safety. For patients, ease of use, fast and accurate drug delivery, and painless injection are the most valuable features of an insulin injection device. For manufacturers, technological feasibility and economic viability also need to be considered when developing injection devices. Conclusion: Insulin pen injectors are generally preferred over vial and syringe, although access may be limited in some health care systems. Insulin pen injectors can adapt to different insulin regimens and formulations and have the potential to acquire dosing data in real time.

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Section: Factors Affecting the Performance Of Insulin Pen Injector Te...mentioning

confidence: 99%

Factors Affecting Performance of Insulin Pen Injector Technology: A Narrative Review

Sparre

Hammershøy

Steensgaard

et al. 2022

J Diabetes Sci Technol

View full text Add to dashboard Cite

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Using Quality Improvement to Design and Evaluate an Outpatient Day Treatment Pathway for Pediatric Patients with Diabetes Mellitus Requiring Insulin Initiation

Azova,

Baskaran,

Einis

et al. 2024

Pediatric Quality &Amp; Safety

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Introduction: Education and management of children with new-onset or established diabetes mellitus (DM) requiring insulin initiation do not always require hospitalization. We developed a pathway for outpatient day treatment of select patients after initial evaluation in the emergency department (ED) at a pediatric, tertiary care academic medical center. Methods: A multidisciplinary team identified key initial eligibility criteria for outpatient day treatment for insulin initiation, including absence of diabetic ketoacidosis, age ≥3 years, and plasma beta-hydroxybutyrate (BOHB) <1 mmol/L. Electronic medical record reviews and surveys administered to endocrine providers determined exclusions or reasons for nonparticipation. Refinement of the pathway occurred through iterative plan-do-study-act cycles. Statistical process control evaluated the uptake among eligible patients. Results: We launched the pathway in September 2020. Of 534 patients presenting to the ED with new-onset or established DM requiring insulin initiation in the first 2.5 years, 198 were potentially eligible for day treatment. Of these, 65 children (33%) completed the pathway. One additional patient was hospitalized following Day 1 of education due to newly identified psychosocial stressors. The increase of BOHB cutoff to 1.5 mmol/L and the option of rapid-acting insulin bolus for borderline BOHB resulted in a significant shift in utilization from a mean of 24.4% to 41.1%. Persistent barriers to participation include limited appointment availability, weekend presentation, and patient/family concerns. Conclusions: Outpatient day treatment was successful for select pediatric patients with new-onset or established DM requiring insulin initiation. However, this approach necessitates flexible resources and supportive patient messaging.

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9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2024

ElSayed,

Aleppo,

Bannuru

et al. 2023

Diabetes Care

172

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The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Starting subcutaneous insulin doses in a paediatric population with newly diagnosed type 1 diabetes

Cited by 4 publications

References 15 publications

Factors Affecting Performance of Insulin Pen Injector Technology: A Narrative Review

Factors Affecting Performance of Insulin Pen Injector Technology: A Narrative Review

Using Quality Improvement to Design and Evaluate an Outpatient Day Treatment Pathway for Pediatric Patients with Diabetes Mellitus Requiring Insulin Initiation

9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2024

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