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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S126-S144. [PMID: 38078575 PMCID: PMC10725813 DOI: 10.2337/dc24-s007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
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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Del Baldo F, Colajanni L, Corradini S, Palagiano P, Di Cunzolo A, Perissinotto L, Drudi I, Horspool L, Fracassi F. Owner preference for insulin delivery device and glycaemic control in diabetic dogs. J Small Anim Pract 2023; 64:255-264. [PMID: 36316285 DOI: 10.1111/jsap.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 04/12/2023]
Abstract
OBJECTIVES To assess treatment satisfaction and owner preference for two delivery devices (VetPen, MSD Animal Health, and U40 insulin syringes) and the effect on glycaemic control in diabetic dogs treated with porcine insulin zinc suspension. MATERIALS AND METHODS Randomised prospective cross-over study with two arms, each of 8 weeks. Twenty client-owned diabetic dogs on insulin treatment by U40 syringe were enrolled. Dogs were randomly assigned to receive insulin by syringe or pen injector for 2 months, followed by 2 months of the other injection method. Treatment satisfaction and owners' insulin delivery device preference were assessed using a questionnaire. Glycaemic control was assessed using a clinical score, serum fructosamine and glycated haemoglobin (HbA1c%) at the time of the enrolment (T0) and the end of each arm of treatment (T2 and T4). RESULTS Treatment satisfaction differed for the two types of the delivery device when the order that each device was used was taken into consideration. Owners who used the syringe first did not have a significant preference for an injection device. In contrast, owners who used the pen injector first expressed a significant preference for VetPen compared to syringes. No significant differences in the number of dogs of Groups 1 and 2 with good and poor glycaemic control at T2 and T4 were detected. CLINICAL SIGNIFICANCE Overall treatment satisfaction and preference for the two delivery methods were similar. However, VetPen was preferred by owners who were randomised to use this device first. Glycaemic control did not appear to be affected by the insulin delivery device used.
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Affiliation(s)
- F Del Baldo
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | - L Colajanni
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
| | - S Corradini
- Clinica Veterinaria dell'Orologio, Sasso Marconi, Italy
| | | | | | | | - I Drudi
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - L Horspool
- MSD Animal Health, Boxmeer, The Netherlands
| | - F Fracassi
- Department of Veterinary Medical Science, University of Bologna, Bologna, Italy
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3
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Sparre T, Hammershøy L, Steensgaard DB, Sturis J, Vikkelsøe P, Azzarello A. Factors Affecting Performance of Insulin Pen Injector Technology: A Narrative Review. J Diabetes Sci Technol 2023; 17:290-301. [PMID: 36540004 PMCID: PMC10012375 DOI: 10.1177/19322968221145201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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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Affiliation(s)
- Thomas Sparre
- Novo Nordisk A/S, Søborg, Denmark
- Thomas Sparre, MD, PhD, Novo Nordisk A/S,
Vandtårnsvej 112, Søborg 2860, Denmark.
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA. 7. Diabetes Technology: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S111-S127. [PMID: 36507635 PMCID: PMC9810474 DOI: 10.2337/dc23-s007] [Citation(s) in RCA: 110] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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, a multidisciplinary 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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Abstract
The American Diabetes Association (ADA) "Standards of Medical 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, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), 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, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Malerba E, Fracassi F, Del Baldo F, Golinelli S, Ceccherini M, Barbarossa A. The accuracy and precision of insulin administration using human and veterinary pen-injectors and syringes for administration of insulin. J Vet Intern Med 2021; 35:1255-1264. [PMID: 33991138 PMCID: PMC8163132 DOI: 10.1111/jvim.16126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Many diabetic dogs and cats require small doses of insulin that must be administered accurately. OBJECTIVES To compare the accuracy and precision of insulin syringes and pen-injectors. ANIMALS None. METHODS To determine how accurately and precisely insulin doses are delivered, 0.5, 1, 2, 4, 8, and 16 U doses were dispensed 25 times from 5 SoloSTARs, 5 FlexPens, 5 KwikPens, 5 JuniorSTARs, 5 VetPens 0.5-8 U, 5 VetPens 1-16 U, and by 5 veterinarians using 30 U/0.3 mL and 40 U/mL insulin syringes. Each dose was weighed, using a precision balance, and the intended and delivered doses were compared. RESULTS All pen-injectors delivered less insulin than the intended dose, underdosage being inversely proportional to insulin dose. The differences between the intended and the delivered dose were not significant using JuniorSTAR and VetPen 0.5-8 U at insulin doses of 0.5, 1, 2, and 4 U, using the 30 U/0.3 mL insulin syringe at the 4 U dose and using the 40 U/mL insulin syringe at the 4, 8, and 16 U doses. With all the devices, precision increased with increasing doses of insulin. The coefficient of variation was <8% for all 6 pen-injectors. Conversely, using 30 U/0.3 mL and 40 U/mL syringes at an insulin dosage of 0.5 U the coefficients of variation were 12.08% and 9.39%, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE JuniorSTAR and VetPen 0.5-8 U were more accurate than the other devices when delivering ≤2 U doses, while the delivery of 8 and 16 U doses was more accurate using 40 U/mL syringes.
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Affiliation(s)
- Eleonora Malerba
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Federico Fracassi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Francesca Del Baldo
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Stefania Golinelli
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Martina Ceccherini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Andrea Barbarossa
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
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Warren ML, Brod M, Håkan-Bloch J, Sparre T, Chaykin LB. Patient-reported outcomes from a randomized, crossover trial comparing a pen injector with insulin degludec versus a pen injector with insulin glargine U100 in patients with type 2 diabetes. Curr Med Res Opin 2019; 35:1623-1629. [PMID: 30974973 DOI: 10.1080/03007995.2019.1605769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Type 2 diabetes (T2D) is associated with insulin resistance and deteriorated glycemic control that can be restored with insulin injections. Choice of insulin pen injector may affect complexity, adherence, efficacy of treatment and health-related quality of life. We describe detailed patient-reported outcomes (PROs) on treatment impact and preference comparing insulin degludec (degludec) using FlexTouch1 versus insulin glargine U100 (glargine U100) with SoloStar2 pen injector.Methods: In this randomized, multicenter (USA), open-label, crossover, treat-to-target study (NCT01570751), patients with T2D using high-dose insulin (≥81 U/day from vials) were randomized (n = 145) 1:1 to 16 weeks of degludec U200 (3 mL FlexTouch) followed by 16 weeks of glargine U100 (3 mL SoloStar) or vice versa. PRO questionnaires assessed treatment impact and patient preference of pen injectors.Results: Significantly more patients (p < .01) considered FlexTouch "extremely easy" for learning (62.5 vs. 43.0%), maintaining (63.2 vs. 42.2%) and adjusting the dose (63.2 vs. 44.4%), and significantly more were "very" or "extremely confident" in using the device (60.3 vs. 36.3%) and in its accuracy (50.7 vs. 30.4%) versus SoloStar. Significantly more were "not at all bothered" by device discomfort (74.3 vs. 54.1%), whereas device size (83.8 vs. 80.0%) or public use (69.9 vs. 60.7%) were numerically in favor of FlexTouch. Significantly more patients preferred degludec treatment with FlexTouch (59 vs. 22%), preferred to continue (67 vs. 15%) and recommend (67 vs. 14%) use of FlexTouch compared with SoloStar with glargine U100.Conclusions: In this randomized, crossover trial, lower treatment impact and higher patient preference were reported for FlexTouch versus SoloStar pen injectors.
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Affiliation(s)
| | | | | | - Thomas Sparre
- Medical & Science Devices & Titration, Novo Nordisk A/S, Søborg, Denmark
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Zijlstra E. Analysis of "Laboratory and Benchtop Performance of a Mealtime Insulin Delivery System". J Diabetes Sci Technol 2018; 12:828-830. [PMID: 29619894 PMCID: PMC6134312 DOI: 10.1177/1932296818767940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the current issue of Journal of Diabetes Science and Technology, Dreon et al give a comprehensive overview of the technical performance of a wearable patch for bolus insulin delivery. The test results generated by the manufacturer of the bolus-patch provide the technical prerequisites for clinical application. As the device received FDA clearance already in 2010, positive results from the nonclinical performance testing were to be expected, but present nevertheless interesting insights into the device development. The single-dose accuracy verification results seem especially promising, but tighter accuracy criteria could have been specified and information on outliers is missing from the analysis. The clinical application of the bolus-patch is currently under investigation in a large-scale 44-week intervention trial.
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Affiliation(s)
- Eric Zijlstra
- Profil, Neuss, Germany
- Eric Zijlstra, PhD, Profil,
Hellersbergstrasse 9, Neuss, 41460, Germany.
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Zijlstra E, Jahnke J, Fischer A, Kapitza C, Forst T. Impact of Injection Speed, Volume, and Site on Pain Sensation. J Diabetes Sci Technol 2018; 12:163-168. [PMID: 28990437 PMCID: PMC5761988 DOI: 10.1177/1932296817735121] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Painful subcutaneous insulin injections may decrease treatment compliance. Improving injection comfort therefore represents a particular area of technological research in which steady progress has been made since the introduction of the insulin pen in 1985. Injection pain can be influenced by many variables, but relatively little is known about their impact. This study investigated the impact of injection volume (range 0-2250 µL), speed (range 0-800 µL/sec), and site (abdomen vs thigh) on pain sensation. METHOD In random order, patients (n = 80) with type 1 or type 2 diabetes received 24 saline injections subcutaneously through a 27G ultra-thin-wall needle. Injections were performed in the abdomen (n = 19) and thigh (n = 5) with predefined speed-volume combinations. For each injected speed-volume combination, patients scored their pain sensation on a 100 mm visual analog scale (VAS). RESULTS The mean pain scores for speed-volume combinations were all in the lower part (<20 mm) of the VAS, indicating zero to mild pain. Pain sensation was statistically higher ( P < .05) with the 2250 µL volume compared to other injection volumes (range 4.3-5.1 mm) and with thigh compared to abdomen injections (2.1 mm). Pain sensation did not change with increasing injection speed. Patient acceptance of the injection pain was high for all injections (range 93.7-98.7%). CONCLUSIONS In summary, large volume and thigh injections are rated more painful, but the clinical impact of these findings is likely marginal considering the low absolute pain levels and high patient acceptance rates. Injection speed does not influence pain sensation.
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Affiliation(s)
- Eric Zijlstra
- Profil, Neuss, Germany
- Eric Zijlstra, PhD, Profil, Hellersbergstrasse 9, Neuss, 41460, Germany.
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Affiliation(s)
- Luigi F Meneghini
- 1 Division of Endocrinology, UT Southwestern Medical Center , Dallas, Texas
- 2 Global Diabetes Program, Parkland Health & Hospital System , Dallas, Texas
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Lasalvia P, Barahona-Correa JE, Romero-Alvernia DM, Gil-Tamayo S, Castañeda-Cardona C, Bayona JG, Triana JJ, Laserna AF, Mejía-Torres M, Restrepo-Jimenez P, Jimenez-Zapata J, Rosselli D. Pen Devices for Insulin Self-Administration Compared With Needle and Vial: Systematic Review of the Literature and Meta-Analysis. J Diabetes Sci Technol 2016; 10:959-66. [PMID: 26920639 PMCID: PMC4928229 DOI: 10.1177/1932296816633721] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Pen devices offer advantages compared with vial and syringe (VaS). The purpose of this article was to evaluate efficacy of pen devices compared to VaS. METHODS A systematic review of literature was performed in 8 different databases. References were independently screened and selected. Primary observational or experimental studies comparing pen devices with VaS for insulin administrations were included. Studies on specific populations were excluded. Risk of bias was evaluated using appropriate tools. Data on glycosylated hemoglobin (HbA1c), hypoglycemia, adherence, persistence, patient preference, and quality of life (QOL) were collected. Meta-analysis was performed when appropriate. Heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses of the available data was done. RESULTS In all, 10 348 articles were screened. A total of 17 studies were finally selected: 7 experimental and 10 analytical. The populations of the included articles were mainly composed of adults with type 2 diabetes mellitus. Important risk of bias was found in all of the articles, particularly experimental studies. Meta-analyses were performed for HbA1c, hypoglycemia, adherence and persistence. Pen device showed better results in mean HbA1c change, patients with hypoglycemia, adherence and persistence compared to VaS. No difference was observed in number of patients achieving <7% HbA1c. Preference studies showed a tendency favoring pen devices, however nonvalidated tools were used. One QoL study showed improvements in some subscales of SF-36. CONCLUSIONS There is evidence that pen devices offer benefits in clinical and, less clearly, patient-reported outcomes compared to VaS for insulin administration. However, these results should be taken with caution.
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Affiliation(s)
| | | | | | | | - Camilo Castañeda-Cardona
- Pontificia Universidad Javeriana, Medical School, Bogota, Colombia NeuroEconomix SAS, Bogota, Colombia
| | | | - Juan José Triana
- Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
| | | | | | | | | | - Diego Rosselli
- Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
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Moorman Spangler CM, Greck BD, Killian JH. Analysis of a Delivery Device Conversion for Insulin Aspart: Potential Clinical Impact in Veterans. Clin Diabetes 2016; 34:92-6. [PMID: 27092019 PMCID: PMC4833489 DOI: 10.2337/diaclin.34.2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In Brief Insulin therapies using a wide variety of delivery devices are available to accommodate individual patients' needs. In this study of veterans with diabetes, converting from insulin aspart delivered with vials and syringes to insulin aspart delivered via a pen device resulted in no significant change in A1C. Although insulin pen delivery devices offer benefits, providers should thoroughly consider all potential reasons for uncontrolled diabetes before modifying a patient's insulin delivery method.
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Affiliation(s)
- Caitlin M. Moorman Spangler
- Department of Population Health, Novant Health, Winston-Salem, NC
- Department of Research, Charles George VA Medical Center, Asheville, NC
| | - Beth D. Greck
- Department of Pharmacy, Charles George VA Medical Center, Asheville, NC
| | - Jancy H. Killian
- Department of Pharmacy, Charles George VA Medical Center, Asheville, NC
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Klonoff D, Nayberg I, Thonius M, See F, Abdel-Tawab M, Erbstein F, Haak T. Accuracy and Injection Force of the Gla-300 Injection Device Compared With Other Commercialized Disposable Insulin Pens. J Diabetes Sci Technol 2015; 10:125-30. [PMID: 26311720 PMCID: PMC4738217 DOI: 10.1177/1932296815601441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND To deliver insulin glargine 300 U/mL (Gla-300), the widely used SoloSTAR(®) pen has been modified to allow for accurate and precise delivery of required insulin units in one-third of the volume compared with insulin glargine 100 U/mL, while improving usability. Here we compare the accuracy and injection force of 3 disposable insulin pens: Gla-300 SoloSTAR(®), FlexPen(®), and KwikPen™. METHODS For the accuracy assessment, 60 of each of the 3 tested devices were used for the delivery of 3 different doses (1 U, half-maximal dose, and maximal dose), which were measured gravimetrically. For the injection force assessment, 20 pens of each of the 3 types were tested twice at half-maximal and once at maximal dose, at an injection speed of 6 U/s. RESULTS All tested pens met the International Organization for Standardization (ISO) requirements for dosing accuracy, with Gla-300 SoloSTAR showing the lowest between-dose variation (greatest reproducibility) at all dose levels. Mean injection force was significantly lower for Gla-300 SoloSTAR than for the other 2 pens at both half maximal and maximal doses (P < .0271). CONCLUSION All tested pens were accurate according to ISO criteria, and the Gla-300 SoloSTAR pen displayed the greatest reproducibility and lowest injection force of any of the 3 tested devices.
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Affiliation(s)
- David Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, CA, USA
| | - Irina Nayberg
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, CA, USA
| | | | - Florian See
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | | | - Frank Erbstein
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Thomas Haak
- Diabetes Klinik Bad Mergentheim, Bad Mergentheim, Germany
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Abstract
During the last several decades, a proliferation of sophisticated technology has taken place to facilitate diabetes self-management and improve health outcomes. Blood glucose monitors, insulin pumps, and continuous glucose monitors have significant data storage capacity, which can be used to summarize diabetes health management and outcomes. In the absence of technology errors or failures, and in the context of the multiple psychosocial factors associated with nonadherence, these data have the potential to elucidate diabetes care because they reflect actual patient behaviors. This review provides a summary of the diabetes adherence literature in the context of current American Diabetes Association Clinical Practice Recommendations with a focus on studies that have used objective methods (ie, data derived from technology) to assess diabetes care provider and patient adherence in the areas of glucose monitoring; insulin administration and antihyperglycemic medications; medical nutrition therapy; and physical activity.
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Affiliation(s)
- Kimberly A Driscoll
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL, 32306-4300, USA,
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