Adherence and persistence to a regimen of basal insulin in a pre-filled pen compared to vial/syringe in insulin-naïve patients with type 2 diabetes

Buysman, Erin; Conner, Christopher S.; Aagren, Mark; Bouchard, Jonathan; Liu, Fang

doi:10.1185/03007995.2011.598500

Cited by 42 publications

(54 citation statements)

References 29 publications

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“…In all these studies, the pen devices were preferred to the vial-and-syringe injection systems, especially for reasons of accuracy and convenience. [17][18][19][20] Clinically, insulin pens show an advantage through improved adherence and reduced hypoglycemic events. Furthermore, overall health care costs were either unchanged or improved in insulin pen users as compared with those using insulin vials and syringes, although little economic advantage was observed when switching from insulin vials to insulin pens.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Patient Preference for Two Insulin Injection Pen Devices in Relation to Patient Dexterity Skills

Pfützner

Schipper

Niemeyer

et al. 2012

J Diabetes Sci Technol

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Section: Discussionmentioning

confidence: 99%

Comparison of Patient Preference for Two Insulin Injection Pen Devices in Relation to Patient Dexterity Skills

Pfützner

Schipper

Niemeyer

et al. 2012

J Diabetes Sci Technol

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“…Six studies with a follow-up of 12 months were found, [13][14][15]18,19,26 with statistically significant difference in favor of pen ( Figure 2F), but important heterogeneity (I 2 = 89%) was detected. A subanalysis was performed using the studies with similar definitions of discontinuation threshold.…”

Section: Persistencementioning

confidence: 99%

“…13,15,23,26 Proportion of days covered (PDC) is calculated in a similar fashion to MPR. 16 Four studies 13,15,23,26 assessed final MPR at 12-month follow-up, and showed statistically significant difference favoring pen, but had considerable heterogeneity (I 2 = 95%) ( Figure 2E). When insulin-naïve and nonnaïve populations were compared, and a greater difference was seen in the former population.…”

Section: Adherencementioning

confidence: 99%

Pen Devices for Insulin Self-Administration Compared With Needle and Vial

Lasalvia

Barahona-Correa

Romero-Alvernia

et al. 2016

J Diabetes Sci Technol

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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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“…43 In addition, the use of pharmacy claims data to measure adherence and persistence with treatment does not necessarily provide detailed information since a prescription claim does not confirm the drug was taken, or taken as prescribed. A further limitation is the lack of generalizability of the results of the analysis since the population of retirees with Medicare Supplemental insurance may not represent the US elderly population as a whole.…”

Section: Study Limitationsmentioning

confidence: 99%

Does Device Make Any Difference? A Real-world Retrospective Study of Insulin Treatment Among Elderly Patients With Type 2 Diabetes

Miao

Wei

Lin³

et al. 2014

J Diabetes Sci Technol

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Background: We compared real-world clinical and economic outcomes for insulin glargine treatment administered by disposable pen and traditional vial-and-syringe injections among elderly patients with type 2 diabetes mellitus (T2DM). Methods: Using a large database of US retirees, this retrospective longitudinal study examined 1-year follow-up outcomes in patients with T2DM aged 65 years or older who were either insulin naïve and initiated insulin glargine via disposable pen (pen initiators [PI]) or vial (vial initiators [VI]) or were already insulin glargine users but either continued with a vial (vial continuers [VC]) or switched to a disposable pen (pen switchers [PS]). Results: There were 7856 propensity-score-matched patients, including 2930 each in the PI and VI cohorts, and 998 each in the VC and PS cohorts. Compared with vial-and-syringe users, the disposable pen users had significantly greater treatment persistence (P < .0001 for both comparisons), duration of persistence (P < .0001 for both), and adherence (P < .01 for both) and lower insulin daily average consumption (P < .05 for both). Compared with the VI cohort, the PI cohort had significantly fewer hypoglycemia-related events (P = .0164). Total health care costs were comparable for the respective matched cohorts. Conclusions: In elderly patients with T2DM receiving insulin glargine therapy, initiating or switching to a disposable pen was associated with better treatment persistence and adherence than initiating or continuing with vial-and-syringe, without increased total health care costs. Among insulin-naïve patients, initiating insulin glargine by disposable pen was also associated with significantly reduced risk of hypoglycemia compared with vial-and-syringe patients.

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Adherence and persistence to a regimen of basal insulin in a pre-filled pen compared to vial/syringe in insulin-naïve patients with type 2 diabetes

Abstract: These results suggest that persistence and adherence with insulin may be improved for patients initiating basal insulin therapy with Levemir FlexPen versus NPH vial.

Cited by 42 publications

References 29 publications

Comparison of Patient Preference for Two Insulin Injection Pen Devices in Relation to Patient Dexterity Skills

Comparison of Patient Preference for Two Insulin Injection Pen Devices in Relation to Patient Dexterity Skills

Pen Devices for Insulin Self-Administration Compared With Needle and Vial

Does Device Make Any Difference? A Real-world Retrospective Study of Insulin Treatment Among Elderly Patients With Type 2 Diabetes

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