This advertorial was sponsored by Novo Nordisk. The content was approved by the sponsoring company and the author prior to publication.
Prior to 1985, insulin administration for people with diabetes meant using a large glass syringe and a reusable needle, both of which had to be sterilised by boiling.
Gwen Hall is a Diabetes Specialist Nurse in Primary Care, Haslemere, Surrey.
Using this equipment was difficult, time-consuming, inaccurate and tedious, both for the person with diabetes and the healthcare professional (HCP). In this same year, however, the first insulin pen – NovoPen® by Novo Nordisk – was launched. This innovation in insulin delivery was to change the lives of people treated with insulin, improving patient satisfaction and quality of life (QOL) (Rubin and Peyrot, 2004).
This short advertorial discusses the benefits of insulin pens for people with diabetes, the advantages of their use compared with the traditional vial-and-syringe method of insulin delivery, and looks to the future, exploring the unmet needs of current insulin pen devices.
The insulin pen: Benefits for people with diabetes
Over the intervening years from 1985 to the present day, innovation in insulin pen device design has come on leaps and bounds, and the HCP today now has easy-to-use reusable pens that take 3 mL cartridges (much like a fountain pen of old), disposable pens, ones with a memory function – and another with, literally, knobs on! Most function by depressing a plunger; one has a dial like an egg timer, and another a spring-loaded slider that delivers the dose when pressed.
A number of studies highlight several advantages of pen devices over the traditional insulin delivery method of vial and syringe, including greater ease of use and convenience, and improved dosing accuracy, patient satisfaction and medication adherence (Korytkowski et al, 2003; Lee et al, 2006; 2009; Cobden et al, 2007; Sommavilla et al, 2008; Asakura et al, 2009) – all of which are beneficial for people with diabetes who are striving to achieve the tighter glycaemic control levels recommended in national guidelines such as those by NICE (2009) and SIGN (2010).
Compared with people with type 1 diabetes, people with type 2 diabetes are generally older, with multiple comorbidities, and are often taking a range of medications for their diabetes, as well as other conditions. These people may well have poor dexterity and vision, which, in some people, can be mitigated by the improved legibility of the dose displayed on their insulin pen when compared with vial and syringe. Many insulin pen devices have an audible “click” sound on turning the dose selector to alert the user to the dosage achieved, which is particularly helpful for those people with impaired vision.
The process of mixing insulins has also been eliminated with the advent of insulin pens, removing the potential risk of damaging rapid-acting insulin from contamination during this process (Bailey and Edelman, 2010).
Regarding dose accuracy and size, there are pens that deliver in 1 unit increments – especially suited to children and those on small doses of insulin – and those that deliver in 2 unit increments. Some insulin pens go up to 40 units in a single dose, others up to 80 units, allowing those on higher insulin doses to take their medication in one dose. Other pens that have a lower maximum dose amount require the individual to re-dial with the needle in situ (not easy) or take two injections. However, this ability to deliver the higher 80 units of insulin in one dose often requires a large reach of the user’s thumb (often referred to as “wingspan”) to depress the plunger, which can be difficult for people with reduced dexterity. Two important features, from my point of view, are the ability to turn back the dose without losing any insulin and the inability to choose a dose that amounts to more than the device contains. It all simplifies the time spent teaching and helps the person with diabetes to take their insulin in the easiest and most convenient way possible, which is paramount in allowing these individuals to maintain their independence and to self-manage their condition safely.
Patient choice is also now greater than ever, with a spectrum of insulin pens available; there are jazzy pens, stainless steel pens, and devices with magnifier windows. Such an array of devices, along with the simplicity of using an insulin pen, means that HCPs’ time is freed up for discussing the merits of a variety of systems and matching the device to the individual’s lifestyle and insulin regimen, rather than spending time teaching how to correctly administer insulin by vial and syringe. Some people may have a preference for pens that take cartridges, that are discreet, that are easy to carry around (Bohannon, 1999). Whichever system is chosen, the individual’s QOL is improved with a pen over a vial and syringe (Rubin and Peyrot, 2004; Lee et al, 2009).
Looking to the future: Is there an unmet need?
Innovation is an ongoing process, and the manufacturers of insulin pen devices are continually striving to improve on the currently available insulin pens to enable truly tailored care for people with diabetes. Patients and carers need insulin delivery devices they can rely on, that are easy to use, with the minimum of steps to carry out.
I know from experience that speed counts and size matters to my patients – busy people want something discreet and
quick. Fitting the needle and selecting the dose needs to be performed with the minimum of fuss. The screen needs to be easy to see, the clicks easy to hear. The dose selector should allow higher doses of insulin to be administered without the need for re-dialling or injecting twice. The plunger button needs to be easy to reach and easy to depress, without the need for a large wingspan reach of the user. Developments in all these areas would make insulin administration easier, potentially increasing patient satisfaction, adherence and QOL.
On my personal wish list? A needle that is easy to fit. As mentioned above, a pen that has little or no wingspan required; a pen with an alarm that sounds when an injection is due; a built-in memory to assist with the new range of carbohydrate-counting blood glucose meters, and more knobs on for people with limited grip and dexterity. A pen that can assist people with diabetes by indicating when the full dose has been delivered, which would be particularly useful for people with impaired vision. Oh, and if it helped HCPs avoid needlestick injuries, so much the better.
Insulin pens offer a number of options to allow insulin administration to be tailored to the person with diabetes, and are associated with a range of benefits both for patients and for HCPs. Newer pens are increasingly user-friendly and require less time to teach than the traditional vial-and-syringe method; they are also more accurate and more convenient. However, the need for innovation is just as important now as it was in 1985, and the current devices can and should be improved upon to optimise outcomes for the growing population with diabetes.
UK/DV/0911/0040b Date of Preparation: September 2011
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Bohannon N (1999) Insulin delivery using pen devices: Simple-to-use tools may help young and old alike. www.sugarnancy.com. Available at: http://bit.ly/nzRvuN (accessed 22.08.11)
Cobden D, Lee WC, Balu S et al (2007) Health outcomes and economic impact of therapy conversion to a biphasic insulin analog pen among privately insured patients with type 2 diabetes mellitus. Pharmacotherapy 27: 948–62
Korytkowski M, Bell D, Jacobsen C et al (2003) A multicenter, randomized, open-label, comparative, two-period crossover trial of preference, efficacy, and safety profiles of a prefilled, disposable pen and conventional vial/syringe for insulin injection in patients with type 1 or 2 diabetes mellitus. Clin Ther 25: 2836–48
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NICE (2009) Type 2 Diabetes: The Management of Type 2 Diabetes. NICE, London
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