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      Dialing Torque Preferences of People with Diabetes When Using Insulin Pens: A Pilot Study

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          Abstract

          Introduction

          Ergonomic dialing torque may enhance safety and comfort when setting doses with insulin pens. Limited data are available on the correlation of dialing torque and dialing comfort.

          Methods

          Three studies were performed with SoloSTAR ® (SS; Sanofi), FlexPen ® (FP; Novo Nordisk), KwikPen ® (KP; Eli Lilly) and FlexTouch ® (FT; Novo Nordisk) pens. Dialing behavior was examined with 20 pen-experienced people with diabetes. Participants dialed up to the maximum dose and back down to “zero” with each pen. Hand and pen movements were recorded by video camera and rotational speeds and angles calculated for each pen. In a laboratory study, dialing torque was measured discontinuously at a speed of 120°/s, reflecting typical patient behavior. Sixteen pen-experienced people with diabetes participated in a pilot preference study. Using a Likert scale, subjective dialing comfort rankings and ratings were obtained for each pen type and matched to their dialing torque. SS, FP, KP, and FT1 were investigated at 0–20 U each and at 60–80 U for FT2.

          Results

          SS was ranked most comfortable for up-dialing by 8 and down-dialing by 6 of the 16 participants, respectively; FP, 5 and 8; FT1, 2 and 1; and KP, 1 and 1. FT2 was ranked least comfortable by 12 and 10 participants. Comfort for up- and down-dialing was rated “very comfortable” for SS by 15 participants each, followed by FP (12 and 14), KP (10 each), and FT1 (9 and 7); FT2 was rated “less” or “not” comfortable by 10 and 11 people, respectively.

          Conclusion

          In this pilot study, subjective ratings of dialing comfort for different insulin pens by participants appear to concur with previous laboratory dialing torque study results. There appears to be a “torque comfort zone.” Torques above 50 N mm reduced subjective handling comfort. Further, larger scale studies are needed to establish that dialing torque affects pen users’ comfort.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s13300-015-0097-z) contains supplementary material, which is available to authorized users.

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          Most cited references 13

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          Insulin delivery with FlexPen: dose accuracy, patient preference and adherence.

          The introduction of insulin pens has helped improve adherence in Type 1 or 2 diabetes, and reduce inaccurate dosing, fear of injection, and social embarrassment associated with vial and syringe. This report presents the published evidence base for the accuracy, patient preference and economic evaluation of one prefilled pen, FlexPen (Novo Nordisk A/S, Bagsvaerd, Denmark) and discusses recent changes to the design of this pen. Primary research publications that included the study of FlexPen were identified from various sources. Several studies have shown that FlexPen delivers high, medium and low doses of insulin significantly more accurately than vial and syringe, SoloStar (sanofi-aventis, Paris, France) or OptiClik (sanofi-aventis, Paris, France). Patients have also found FlexPen easier to use than vial and syringe. A Next Generation FlexPen has been developed, which maintains the demonstrated accuracy of FlexPen and is accompanied by a reduced injection force for simpler and more comfortable use, and clear colour scheme for insulin type to avoid medication errors.
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            Dosing accuracy of insulin pens versus conventional syringes and vials.

            Pen injection devices have acquired a pivotal role in insulin delivery, surpassing the use of conventional insulin syringes in many parts of the world. In this review we sought to determine differences in dosing accuracy between insulin pens and conventional syringes and vials, also touching on patient preference. We aggregated relevant literature found by searching the PubMed database, identifying seven relevant articles. There was consensus that pens are more accurate, especially at doses below 5 insulin units (IU). The literature also showed that pens tend to underdose when compared to syringes, but do this with a high degree of consistency. One study assessed influence on glycemic control, and whereas no significant difference was found with respect to hemoglobin A1c, fasting glucose levels decreased significantly more in pen users versus syringe users (-57 +/- 14 vs. 1 +/- 13 mg/dL, P = 0.003). The same study demonstrated that pens improved health-related quality of life compared to syringes and vials. We conclude that, regarding accuracy, there is sufficient evidence to recommend the use of insulin pens when delivering doses below 5 IU. For insulin doses above 5 IU there is no clear benefit for the pen in terms of accuracy.
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              Study on the dosing accuracy of commonly used disposable insulin pens.

              Improved patient comfort and optimal glycemic control have led to the widespread use of insulin pens, particularly in Europe. Most of the former studies on the dose accuracy of insulin pens included only a small number of doses and pens. In extension to our previous large-scale study testing the dosing accuracy following a randomized dosing sequence with each pen, the present study was more directed toward the dose accuracy for one specific dose dispensed repeatedly with the same pen. This is the first study providing detailed comparative data on the accuracy of repeated dose delivery with prefilled disposable insulin pens at low, middle, and high doses, dispensed over the entire pen volume.
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                Author and article information

                Contributors
                arnd.friedrichs@lwsgroup.com
                Journal
                Diabetes Ther
                Diabetes Ther
                Diabetes Therapy
                Springer Healthcare (Heidelberg )
                1869-6953
                1869-6961
                27 January 2015
                27 January 2015
                March 2015
                : 6
                : 1
                : 85-93
                Affiliations
                [ ]LWS Risk Management Consult GmbH, Brannenburg, Germany
                [ ]Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
                Article
                97
                10.1007/s13300-015-0097-z
                4374073
                25619548
                © The Author(s) 2015
                Categories
                Original Research
                Custom metadata
                © Springer Healthcare 2015

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