The Role of Comfort and Discomfort in Insulin Therapy

Abstract

Despite the recognized importance of optimal insulin therapy, patient adherence to insulin therapy is an ongoing clinical care challenge. Insulin omission continues to be frequent and underestimated and has been correlated with poorer glycemic control and increased rates of diabetes-related complications. Insulin users consistently indentify multiple factors that contribute to insulin injection-related anxiety and to non-adherence. Injection-related discomfort continues to bear a significant contribution. Over the last decade, with advances in needle manufacturing technology, shorter and narrower needles have been associated with progressively improving patient self-rating of injection discomfort. Consequently, patient surveys of insulin users show discomfort to rank in the bottom third of significant contributors by prevalence. However, healthcare providers (HCP) and family member care providers continue to demonstrate a high level of anticipated and perceived pain for the patient. HCP anxiety and pain anticipation are each associated with patient anxiety and may therefore play a significant contributing role in patient non-adherence.

Medication Therapy Review of Elderly Who’s Receiving Insulin

“…Insulin is a high alert drug, it needs special services to deliver insulin to the patient to be used properly and safely. [10] Pharmacists have a strategic role in the monitoring and evaluation of patients treatment to detect symptoms that can be attributed to side effects caused by current treatment, interpreting, monitoring, and assessing the outcomes of patients' treatment. Through the MTR service, the Pharmacist may assess, identify, and prioritize treatment related to issues related to the clinical suitability of each drug used by the patient, including benefits versus risk, dose adjustment and dose regimen of each drug, including indication, contraindications, potential side effects, and potential treatment-related problems.…”

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

“…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.…”

“…Appropriate education on injection techniques is obviously essential, nevertheless it is often lacking [4], as shown by the high rate of skin lesions caused by incorrect injecting habits [11,36,[38][39][40][41][42][43][44][45][46][47][48][49][50].…”

“…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.…”

“…In addition, 39.1% patients with lipohypertrophy showed unexplained hypoglycaemia and 49.1% had high glycaemic variability. Several studies show that insulin absorption from lipodystrophic areas can be delayed or become unpredictable [47][48][49][50], thus representing a potential factor of worsening glycaemic control [50][51][52][53][54][55][56][57][58], while the use of very short needles is preferred by patients [35,37,38] and is less traumatic per se [39,42]. …”