Attributes Influencing Insulin Pen Preference Among Caregivers and Patients With Diabetes Who Require Greater Than 20 Units of Mealtime Insulin

Abstract

Background: This study compared patient preference for Humalog® KwikPen™ 200 units/mL (insulin lispro; hereafter, IL 200 pen; Eli Lilly and Company, Indianapolis, IN) versus the Humalog KwikPen 100 units/mL (insulin lispro; hereafter, IL 100 pen; Eli Lilly and Company, Indianapolis, IN) in patients with diabetes requiring >20 units of mealtime insulin and diabetes caregivers. This study also determined which attributes had the greatest influence on pen preference selection. Methods: In this 2-period, crossover, simulated-use study, 106 participants were randomized to 1 of 8 sequences that varied the pen order (IL 100 pen or IL 200 pen) and dosing order (15 units = low dose or 50 units = high dose) for a total of 4 simulated injections. Participants then completed a self-administered questionnaire to select their overall preference between the 2 pens and then rated the importance of 11 pen attributes in contributing to their overall preference. Results: Of the 90 participants expressing an overall preference, significantly more preferred the IL 200 pen to the IL 100 pen (IL 200 pen: 80 respondents; IL 100 pen: 10 respondents; 95% confidence interval [0.81, 0.94], P < .0001). The total amount of insulin in the pen, the ease in pressing the injection button, and the amount of fluid injected were key attributes influencing IL 200 pen preference. Conclusions: Based on these key attributes, the IL 200 pen was significantly preferred over the IL 100 pen by patients with diabetes who require >20 daily mealtime insulin units or diabetes caregivers and may improve the injection experience for these patients.

Patient Preferences and Health State Utilities Associated with Mealtime Insulin Concentrations Among Patients with Diabetes in Italy

“…Findings from this Italian sample provide insight into patient preferences associated with rapid-acting insulin concentration. Results are consistent with those from previous studies showing a preference for concentrated over standard insulin [33,35]. The findings of the current study add to previous research by demonstrating the strength of this preference, while providing utility values that can represent patient preference in cost-effectiveness analyses comparing insulin formulations.…”

“…A literature search was conducted to support health state content and guide subsequent discussions with clinicians. The literature search focused on standard (100 units/mL) and concentrated (200 units/mL) insulin lispro product information [18], glide force (i.e., the amount of effort required to press the pen's injection button) [31], and patient perceptions of standard and concentrated insulin [32][33][34][35].…”

Perceptions About Glucagon Delivery Devices for Severe Hypoglycemia: Qualitative Research With Patients, Caregivers, and Acquaintances

“…Consistent with previous studies examining preferences for features of insulin pen devices that included both patients with diabetes and caregivers, this study found that ease of use is a key attribute that influences preferences. 27,28 A device that is easy to use is likely to be associated with fewer errors in administration. Indeed, one study found that >94% of caregivers and 93% of acquaintances delivered full doses of nasal glucagon, whereas only 13% of caregivers and 0% of acquaintances delivered full doses of the existing injectable glucagon.…”

Concentrated insulins in current clinical practice

“…Because the volume is reduced by half in case of switching from U-100 to U-200, the throw of the plunger is likewise reduced by the same magnitude for any given dose of insulin. People with diabetes expressed preference for the use of a U-200 concentrated insulin pen compared to a U-100 insulin pen because of an improved injection experience related to reduced injection volume and reduced injection force of the pen [24].…”

“…The pen provided for Lispro-U200 was found to be preferred over the pen used for Lispro-U100. Reasons for this preference included more units per pen (pen changes are half as frequent), reduced injection force, and a 50% reduction in injection volume [13,24].…”