Comparative glycemic control, safety and patient ratings for a new 4 mm × 32G insulin pen needle in adults with diabetes

Abstract

The 4 mm x 32G PN provided equivalent glycemic control compared to 31G, 5 mm and 8 mm PNs with reduced pain, no difference in insulin leakage and was preferred by patients.

Insulin delivery by injection in children and adolescents with diabetes

“…Today, pen device needles are available in 4-6 mm lengths (30), while the shortest syringe needle is 8 mm (5). The pen needles are also thinner than syringe needles; the gauge of syringe needles is usually 30 (0.30 mm) (5), while pen needles designed for the paediatric population are available in 31 or 32 (0.25 or 0.23 mm) gauge (31). There are several insulin pens available, in both disposable and durable forms, that are commonly used for insulin delivery in children with diabetes (Table 2).…”

AMD-OSDI Consensus on Injection Techniques for People with Diabetes Mellitus

“…Therefore we suggest using pens with short needles (4 mm) just to minimise the risk of intramuscular injections. Also needle gauge (G) and sharpness are important factors in terms of patient acceptance and satisfaction [32][33][34][35]. 4 mm × 32G needles provide both obese and non-obese patients with comparable degrees of metabolic control as 5 mm × 31G and 8 mm × 31G needles but are perceived as less painful and better accepted [34,[36][37][38][39].…”

“…Injection site rotation within large surfaces, needle disposal after each shot and 45° angle pinch technique utilization with needles >6 mm are essential factors to ensure optimal insulin absorption and prevent skin injury [11,15,22,[29][30][31][32][33][34].…”

“…In the transition from a longer needle to a shorter one, there might be differences in insulin absorption, therefore monitoring blood Subcutaneous tissue thickness varies significantly depending on sex, body mass index, age, ethnicity, diabetes type, morphology of the diabetic individual, as well as, on pressure exerted during injection [8,11,14]. The risk of intramuscular injections depends on that all and has been estimated to be 15.3% with 8 mm, 5.7% with 6 mm and 0.4% with 4 mm needles [14,[26][27][28].Injection site rotation within large surfaces, needle disposal after each shot and 45° angle pinch technique utilization with needles >6 mm are essential factors to ensure optimal insulin absorption and prevent skin injury [11,15,22,[29][30][31][32][33][34].With the advent of insulin analogues, absorption varies much less both between and within individuals and is therefore more predictable and easier to handle by the patient [30]. However, despite technological advances allowing newer and newer insulin analogue availability, certain absorption/ action affecting factors still remain, such as exercise, counterregulatory hormones, high dosage, incorrectly mixed preparations or even the habit to pull out needles from the skin too early after pen pistons reaching their end stroke positions [29,30].…”

“…Also needle gauge (G) and sharpness are important factors in terms of patient acceptance and satisfaction [32][33][34][35]. 4 mm × 32G needles provide both obese and non-obese patients with comparable degrees of metabolic control as 5 mm × 31G and 8 mm × 31G needles but are perceived as less painful and better accepted [34,[36][37][38][39].Injecting insulin by shorter and thinner pen needles (4 mm and 32G) with triple bevels, in compliance with the UNI EN ISO 7864 standards, cause less pain and discomfort [14,36,[39][40] and ensure better therapy acceptance and adherence. In fact, the greater the outer diameter, the greater the resistance the needle has to face to penetrate the skin and, vice versa, the smaller the outer diameter, the less the feeling of discomfort at injection.…”