Patient Satisfaction Associated With Insulin Administered by Pen or Syringe
Patient Satisfaction Associated With Insulin Administered by Pen or Syringe
Purpose: Patient satisfaction, safety and efficacy outcomes, and cost savings with insulin pens versus conventional insulin delivery via vials and syringes in hospitalized patients with diabetes were compared.
Methods: Patients were recruited from two general medical–surgical units from July 2005 to May 2006. Patients completed a survey regarding satisfaction with the method in which insulin was administered before discharge. Patients completed a telephone survey approximately four weeks after discharge to determine home insulin use. Cost savings were determined using the average wholesale price of insulin vials and syringes, pens, and pen needles.
Results: A total of 94 patients were randomized to receive insulin administered via pen devices (n = 49) or using conventional vials and syringes (n = 45). Significantly more subjects in the pen group prepared or self-injected at least one dose of insulin during hospitalization, wanted to continue taking insulin at home using the method used during hospitalization, and would recommend their method of insulin administration used during hospitalization to other patients with diabetes compared with the vial and syringe group (p < 0.05). A cost saving of $36 per patient was projected if only insulin pens were dispensed during the entire hospital stay compared to insulin vials and syringes (p < 0.05).
Conclusion: Increased patient satisfaction and continuation of the method of insulin administration used in the hospital at home were reported by patients who received insulin pens compared with patients who received conventional vials and syringes during hospitalization. A substantial cost saving was projected for patients in the insulin pen group if insulin pens had been dispensed during their entire hospital stay.
Improvements in glycemic control have been shown to greatly reduce the progression of microvascular complications in patients with diabetes. Adherence to insulin therapy is a major factor in achieving glycemic control. Insulin has conventionally been administered via the subcutaneous route with vials and syringes. Insulin pen devices were developed and introduced in the 1980s by combining the insulin reservoir and syringe into a single component in an effort to overcome barriers to adherence with insulin self-administration and to improve convenience and ease of use for patients.
Despite the availability of insulin pens, hospitals continued to use vials and syringes for subcutaneous injections. One reason that insulin pens were not used in many hospitals was that there was no automatic safety feature that would prevent accidental needle sticks in health care workers. The use of insulin pens in the hospital setting became a more viable option with the introduction of an insulin pen product with a safety needle that provides a passive safety feature that automatically engages after an injection is administered (NovoFine Autocover 30G disposable safety needle, Novo Nordisk, Princeton, NJ). The safety feature prevents accidental needle sticks and needle reuse and is locked into place throughout needle disposal. The safety needle complys with U.S. Department of Labor Occupational Safety and Health Administration (OSHA) guidelines and appears on OSHA's list of approved safety-engineered sharps devices.
Administration of insulin through pen devices in the ambulatory care setting has been shown to improve insulin regimen adherence and patient satisfaction. Authors of a survey evaluating insulin pen use in patients who previously used vials and syringes found that more patients who used pens reported not missing any injections and felt it was easier to comply with their insulin regimen than when they used conventional vials and syringes.Patients also reported a strong desire to continue using the pens and stated that they would recommend the method to other patients.
Studies in ambulatory care patients have also found that insulin pens have similar effects or improve glycemic control compared with insulin administered using vials and syringes. In a multicenter, randomized, crossover study in 121 patients with type 1 or type 2 diabetes mellitus using conventional insulin administration using vials and syringes or prefilled, disposable insulin pens, a significant improvement in glycosylated hemoglobin (HbA1c) was observed in both treatment groups after a four-week treatment period, with an average reduction in mean HbA1c values of 0.3% in the total population (p < 0.05). Another randomized crossover study assessed the efficacy and safety of and patient compliance with insulin administered from vials and syringes versus prefilled, disposable pens for an eight-week treatment period in patients over age 60 years. The authors found a reduction of 1.1% ± 1.2% in mean ± S.D. HbA1c values for those using insulin pens compared with a 0.6% ± 1.2% reduction with vials and syringes (mean HbA1c value of 8.4% at baseline for both groups) (p < 0.02). An additional study that evaluated the efficacy and safety of and satisfaction with insulin pens among elderly patients with type 2 diabetes found that HbA1c values decreased significantly from 7.8% at baseline to 7.6% at three months after insulin pen use (p < 0.05).
One long-term study followed patients who were newly initiated on insulin pen treatment or insulin treatment administered from a vial with a syringe for a minimum of two years to evaluate outcomes retrievable through an integrated medical and pharmacy claims database containing information for patients enrolled in managed care health plans in the United States (n = 1156). They conducted a pre-analysis and postanalysis to evaluate the effect of converting patients from conventionally administered insulin to insulin pens on adherence, hypoglycemic events, resource utilization, and the associated health care costs. Although the authors did not report findings related to HbA1c values, they found that the likelihood of patients having a hypoglycemic event was significantly reduced after switching to insulin pens (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.37–0.68; p < 0.05), and the rate of hypoglycemia in patients who were considered adherent to insulin decreased by nearly two thirds (incident rate ratio, 0.35; 95% CI, 0.11–0.81; p < 0.05). There were significant decreases in hypoglycemia-attributable emergency department visits (OR, 0.44; 95% CI, 0.21–0.92; p < 0.05) and physician visits (OR, 0.39; 95% CI, 0.24–0.64; p < 0.05) in patients receiving insulin pens, whereas the number of hypoglycemia-related hospitalizations and outpatient visits remained similar after switching from conventionally administered insulin to insulin pens.
One survey of 33 physicians found that 97% of physicians (n = 32) whose patients switched to insulin pens for six weeks in an outpatient setting felt the insulin pen was a better method for insulin delivery overall, 85% felt more confident in their patients' ability to accurately deliver a dose, and 91% felt it was easier to initiate insulin therapy with the insulin pen than with insulin vials to be administered with syringes. Another study evaluated home care nurse resource utilization in 79 ambulatory elderly patients with visual disabilities, motor disabilities, or both who required assistance for insulin preparation and administration using insulin pens or vials and syringes. More patients were able to independently give themselves injections using insulin pens compared with vials and syringes (53% versus 20%, respectively). The mean ± S.D. time spent by nurses to assist with injections for those who used pens (4.2 ± 8.1 minutes) was shorter compared with administration via vials and syringes (5.8 ± 8.9 minutes). The saving in time spent assisting with injections significantly reduced the mean daily nursing cost (calculated from nursing visits to assist patients with insulin injections) for those who used pens versus vials and syringes ($114 versus $196, respectively; p < 0.001).
Direct and indirect costs attributed to diabetes in the United States were $132 billion in 2002. The development of novel insulin technologies that can increase patient adherence, improve patient and health care worker safety, and decrease potential institutional and health care costs has driven organizations to consider using insulin pen devices for hospitalized patients. To the best of our knowledge, there are no published articles that evaluate insulin pen use in hospitalized patients and cost savings or patient satisfaction associated with insulin pen use in the hospital setting. Further, it is not known whether patients who are exposed to insulin pen devices in a hospital setting would continue to use them after hospital discharge or if insurance and reimbursement issues would be barriers to their use. The goals of the current study were to evaluate patient satisfaction, glycemic control, economic effect, and postdischarge insulin administration method by comparing the use of insulin administered through a pen device with the administration of insulin from vials using a syringe in hospitalized patients.
Purpose: Patient satisfaction, safety and efficacy outcomes, and cost savings with insulin pens versus conventional insulin delivery via vials and syringes in hospitalized patients with diabetes were compared.
Methods: Patients were recruited from two general medical–surgical units from July 2005 to May 2006. Patients completed a survey regarding satisfaction with the method in which insulin was administered before discharge. Patients completed a telephone survey approximately four weeks after discharge to determine home insulin use. Cost savings were determined using the average wholesale price of insulin vials and syringes, pens, and pen needles.
Results: A total of 94 patients were randomized to receive insulin administered via pen devices (n = 49) or using conventional vials and syringes (n = 45). Significantly more subjects in the pen group prepared or self-injected at least one dose of insulin during hospitalization, wanted to continue taking insulin at home using the method used during hospitalization, and would recommend their method of insulin administration used during hospitalization to other patients with diabetes compared with the vial and syringe group (p < 0.05). A cost saving of $36 per patient was projected if only insulin pens were dispensed during the entire hospital stay compared to insulin vials and syringes (p < 0.05).
Conclusion: Increased patient satisfaction and continuation of the method of insulin administration used in the hospital at home were reported by patients who received insulin pens compared with patients who received conventional vials and syringes during hospitalization. A substantial cost saving was projected for patients in the insulin pen group if insulin pens had been dispensed during their entire hospital stay.
Improvements in glycemic control have been shown to greatly reduce the progression of microvascular complications in patients with diabetes. Adherence to insulin therapy is a major factor in achieving glycemic control. Insulin has conventionally been administered via the subcutaneous route with vials and syringes. Insulin pen devices were developed and introduced in the 1980s by combining the insulin reservoir and syringe into a single component in an effort to overcome barriers to adherence with insulin self-administration and to improve convenience and ease of use for patients.
Despite the availability of insulin pens, hospitals continued to use vials and syringes for subcutaneous injections. One reason that insulin pens were not used in many hospitals was that there was no automatic safety feature that would prevent accidental needle sticks in health care workers. The use of insulin pens in the hospital setting became a more viable option with the introduction of an insulin pen product with a safety needle that provides a passive safety feature that automatically engages after an injection is administered (NovoFine Autocover 30G disposable safety needle, Novo Nordisk, Princeton, NJ). The safety feature prevents accidental needle sticks and needle reuse and is locked into place throughout needle disposal. The safety needle complys with U.S. Department of Labor Occupational Safety and Health Administration (OSHA) guidelines and appears on OSHA's list of approved safety-engineered sharps devices.
Administration of insulin through pen devices in the ambulatory care setting has been shown to improve insulin regimen adherence and patient satisfaction. Authors of a survey evaluating insulin pen use in patients who previously used vials and syringes found that more patients who used pens reported not missing any injections and felt it was easier to comply with their insulin regimen than when they used conventional vials and syringes.Patients also reported a strong desire to continue using the pens and stated that they would recommend the method to other patients.
Studies in ambulatory care patients have also found that insulin pens have similar effects or improve glycemic control compared with insulin administered using vials and syringes. In a multicenter, randomized, crossover study in 121 patients with type 1 or type 2 diabetes mellitus using conventional insulin administration using vials and syringes or prefilled, disposable insulin pens, a significant improvement in glycosylated hemoglobin (HbA1c) was observed in both treatment groups after a four-week treatment period, with an average reduction in mean HbA1c values of 0.3% in the total population (p < 0.05). Another randomized crossover study assessed the efficacy and safety of and patient compliance with insulin administered from vials and syringes versus prefilled, disposable pens for an eight-week treatment period in patients over age 60 years. The authors found a reduction of 1.1% ± 1.2% in mean ± S.D. HbA1c values for those using insulin pens compared with a 0.6% ± 1.2% reduction with vials and syringes (mean HbA1c value of 8.4% at baseline for both groups) (p < 0.02). An additional study that evaluated the efficacy and safety of and satisfaction with insulin pens among elderly patients with type 2 diabetes found that HbA1c values decreased significantly from 7.8% at baseline to 7.6% at three months after insulin pen use (p < 0.05).
One long-term study followed patients who were newly initiated on insulin pen treatment or insulin treatment administered from a vial with a syringe for a minimum of two years to evaluate outcomes retrievable through an integrated medical and pharmacy claims database containing information for patients enrolled in managed care health plans in the United States (n = 1156). They conducted a pre-analysis and postanalysis to evaluate the effect of converting patients from conventionally administered insulin to insulin pens on adherence, hypoglycemic events, resource utilization, and the associated health care costs. Although the authors did not report findings related to HbA1c values, they found that the likelihood of patients having a hypoglycemic event was significantly reduced after switching to insulin pens (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.37–0.68; p < 0.05), and the rate of hypoglycemia in patients who were considered adherent to insulin decreased by nearly two thirds (incident rate ratio, 0.35; 95% CI, 0.11–0.81; p < 0.05). There were significant decreases in hypoglycemia-attributable emergency department visits (OR, 0.44; 95% CI, 0.21–0.92; p < 0.05) and physician visits (OR, 0.39; 95% CI, 0.24–0.64; p < 0.05) in patients receiving insulin pens, whereas the number of hypoglycemia-related hospitalizations and outpatient visits remained similar after switching from conventionally administered insulin to insulin pens.
One survey of 33 physicians found that 97% of physicians (n = 32) whose patients switched to insulin pens for six weeks in an outpatient setting felt the insulin pen was a better method for insulin delivery overall, 85% felt more confident in their patients' ability to accurately deliver a dose, and 91% felt it was easier to initiate insulin therapy with the insulin pen than with insulin vials to be administered with syringes. Another study evaluated home care nurse resource utilization in 79 ambulatory elderly patients with visual disabilities, motor disabilities, or both who required assistance for insulin preparation and administration using insulin pens or vials and syringes. More patients were able to independently give themselves injections using insulin pens compared with vials and syringes (53% versus 20%, respectively). The mean ± S.D. time spent by nurses to assist with injections for those who used pens (4.2 ± 8.1 minutes) was shorter compared with administration via vials and syringes (5.8 ± 8.9 minutes). The saving in time spent assisting with injections significantly reduced the mean daily nursing cost (calculated from nursing visits to assist patients with insulin injections) for those who used pens versus vials and syringes ($114 versus $196, respectively; p < 0.001).
Direct and indirect costs attributed to diabetes in the United States were $132 billion in 2002. The development of novel insulin technologies that can increase patient adherence, improve patient and health care worker safety, and decrease potential institutional and health care costs has driven organizations to consider using insulin pen devices for hospitalized patients. To the best of our knowledge, there are no published articles that evaluate insulin pen use in hospitalized patients and cost savings or patient satisfaction associated with insulin pen use in the hospital setting. Further, it is not known whether patients who are exposed to insulin pen devices in a hospital setting would continue to use them after hospital discharge or if insurance and reimbursement issues would be barriers to their use. The goals of the current study were to evaluate patient satisfaction, glycemic control, economic effect, and postdischarge insulin administration method by comparing the use of insulin administered through a pen device with the administration of insulin from vials using a syringe in hospitalized patients.
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