Ultra‐short (5 mm) insulin needles: Trial results and clinical recommendations

Strauss, Kenneth; Hannet, I.; McGonigle, John J.; Parkes, JL; Ginsberg, Barry H.; Jamal, Rozmin; Frid, Anders

doi:10.1002/pdi.1960160711

Cited by 44 publications

(36 citation statements)

References 15 publications

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“…Several prior studies have evaluated PNs of differing lengths and diameter-primarily for effect on glycemic control-but also for pain, ease of insertion, pain, and preference. [5][6][7]13,14 The findings in open-label (not blinded) use are clear-patients almost universally prefer smaller, shorter needles. When patients compared 29 G × 12.7 mm to 31 G × 6 mm PNs in a two-period crossover trial, nearly 90% preferred the smaller PN and rated it less painful.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Modified Needle Tip Geometry on Penetration Force as Well as Acceptability, Preference, and Perceived Pain in Subjects with Diabetes

Hirsch

Gibney

Bérubé

et al. 2012

J Diabetes Sci Technol

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Section: Discussionmentioning

confidence: 99%

Impact of a Modified Needle Tip Geometry on Penetration Force as Well as Acceptability, Preference, and Perceived Pain in Subjects with Diabetes

Hirsch

Gibney

Bérubé

et al. 2012

J Diabetes Sci Technol

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Section: Commentsmentioning

confidence: 99%

“…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].…”

Section: Commentsmentioning

confidence: 99%

“…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].…”

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confidence: 99%

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

Gentile¹,

Grassi²,

Armentano³

et al. 2016

Med Clin Rev

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It goes without saying that all people with diabetes should be taught the best injection technique before starting insulin treatment. Nevertheless the extremely high rate of local injection-related skin reactions-i.e., lipodysthrophic lesions-described in literature, proves otherwise.We are hereby presenting a Consensus Document on Injecting Techniques which highlights 18 key points based on a thorough analysis of the available literature and ranked by "Level of evidence" and "Strength of recommendation" according to our National Guideline System.It is meant at providing all professionals involved in diabetes care with a practical guide on how to help patients on insulin perform well. Keywords: Insulin injections; Diabetes mellitus;Recommendations; Lipohypertrophy Was a Consensus Document on Injecting Techniques really needed?According to data from ISTAT (National Institute of Statistic) 2011 report [1] about 3 million people with diabetes mellitus (DM) are living in Italy nowadays, mostly in the South of our country, with a 5.1% prevalence of type 1 DM (T1DM). ARNO 2011 report, on the other side, witnessed in favour of a 10-year lasting ever increasing utilization of newer insulin preparations endowed with a more physiological pharmacokinetics profile, such as rapid-acting and basal analogues, as well as, of innovative therapeutic regimes [2]. In spite of technological progresses, and a general improvement in the quality of care, the 2012 AMD Annals [3] reported that only 22.2% T1DM and 43.8% T2DM patients reached HbA1c levels below 7% (53 mmol/mol), and T2DM patients above 9% (75 mmol/mol) accounted for 25.7% monitored people.Many factors related to insulin administration, storage and handling might contribute to poor metabolic control. Therefore, a major goal of health care teams is to educate patients and caregivers to the best possible injectable drug administration techniques and the most skilful utilization of related available devices.In order to let them reach that goal, we collected all available scientific evidences on this issue and organised it according to well-defined hierarchically distributed criteria targeted at patient's self-management/empowerment [4], and based on National Guideline System [5] with structured education on top. Our Consensus Document on Injecting Techniques represents in fact the final result of this strong clinical effort. Recommendations concerning injectable drug administrationA correct injection technique is essential for insulin and other subcutaneously administered medications to ensure optimal effects in people with diabetes mellitus (DM). It implies the ability to (i) choose the best needles, (ii) rotate injection sites regularly, (iii) handle and store insulin appropriately, (iv) insert needles correctly into the skin, (v) let pen needles inside the skin long enough to get the whole dose be absorbed and (vi) manipulate the skin before and after injection (Table 1) Insulin must be injected into intact subcutaneous tissue and intramuscular shots have to be av...

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“…3 When 5 mm and 8 mm needles were compared in pediatric and adult populations, the 5 mm needle was found to be as efficacious and safe as an 8 mm needle. 4 Obese patients with diabetes are often advised to use longer needles (≥8 mm) because of a clinical perception that longer needles are needed for a correct injection into a thicker layer of subcutaneous fat. However, there is no compelling clinical evidence that injecting deep into the subcutaneous fat produces superior efficacy to an injection into the superficial subcutaneous fat.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Insulin Diluent Leakage Postinjection Using Two Different Needle Lengths and Injection Volumes in Obese Patients with Type 1 or Type 2 Diabetes Mellitus

Ignaut

2012

J Diabetes Sci Technol

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Background: Smaller gauge, shorter needles have been shown to be as safe and effective for insulin delivery as longer needles in many patients. However, in obese patients with diabetes, results have been inconsistent with regard to the impact of needle length on leakage of injectate. Methods: A single-blind, randomized, two-period, crossover study compared injections with 5 mm needles to 8 mm needles regarding leakage, pain, bleeding, and bruising at abdominal injection sites in obese patients with diabetes using 20-and 60-unit (U) volume equivalent injections of sterile insulin diluent. Results: Fifty-six patients (54% male; mean age 56 years; mean body mass index of 36 kg/m 2) with type 1 (n = 13) or type 2 (n = 43) diabetes participated. Median leakage (U) was similar for both needles [0.04 (5 mm/20 U

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Ultra‐short (5 mm) insulin needles: Trial results and clinical recommendations

Cited by 44 publications

References 15 publications

Impact of a Modified Needle Tip Geometry on Penetration Force as Well as Acceptability, Preference, and Perceived Pain in Subjects with Diabetes

Impact of a Modified Needle Tip Geometry on Penetration Force as Well as Acceptability, Preference, and Perceived Pain in Subjects with Diabetes

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

Comparison of Insulin Diluent Leakage Postinjection Using Two Different Needle Lengths and Injection Volumes in Obese Patients with Type 1 or Type 2 Diabetes Mellitus

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