USABILITY AND PATIENT ACCEPTANCE OF PREFILLED OR REUSABLE INSULIN PENS

Öz

Objective: Adherence to insulin therapy is poor in diabetic patients. Insulin pens with many different features have been developed to increase patient satisfaction and compliance to treatment. In our study, we aimed to investigate the usability and acceptance of prefilled or reusable insulin pens.

Material and Methods: One hundred and twenty-six patients with a mean age of 55.3±11.1 years were included. Eighty-nine (71%) patients were female. Sixty-three patients were in prefilled pen group. A questionnaire was used to assess patients’ opinions about their use of insulin pens. Glycemic control parameters, demographic characteristics, treatment protocol and microvascular complications were recorded.

Results: There was no significant difference between the two groups for age (p=0.3), gender (p=0.1), educational status (p=0.6), duration of diabetes (p=0.8), duration of insulin therapy (p=0.2) and mean insulin dose (p=0.1). Ease of use (p=0.8), ergonomics (p=0.3), ease of dose selection (p=0.6), ease of reading the dose scale (p=0.3) did not significantly differ when two groups were compared. Only the number of patients who found to change the needle as 'moderately difficult' was significantly higher in the prefilled pen group (p=0.04).

Conclusion: The applicability of the treatment and patient satisfaction is as important as the treatment given to the patients. However we did not find any important difference between prefilled or reusable pen device in terms of usability and patient satisfaction.

Anahtar Kelimeler

• Diabetes mellitus
• injection
• insulin
• patient satisfaction

Tek Kullanımlık veya Yeniden Kullanılabılır İnsülin Kalemlerinin Hasta Açısından Kabulü ve Kullanılabilirliği

Öz

Amaç: Diyabet hastalarında insülin tedavisine uyum zayıftır. Hasta memnuniyetini ve tedaviye uyumu artırmak için birçok farklı özelliğe sahip insülin kalemleri geliştirilmiştir. Çalışmamızda, tek kullanımlık veya yeniden kullanılabilir kalem kullanan iki hasta grubunda insülin kalemlerinin kullanılabilirliğini ve hasta memnuniyeti üzerindeki etkisini araştırmayı amaçladık.

Gereç ve Yöntemler: Yaş ortalaması 55.3±11.1 yıl olan 126 hasta çalışmaya dahil edildi. Hastaların 89 (%71)’u kadındı. Tek kullanımlık kalem grubunda 63 hasta vardı. İnsülin kalemleri kullanımıyla ilgili hasta görüşlerini değerlendirmek için bir anket kullanıldı. Glisemik kontrol parametreleri, demografik özellikler, tedavi protokolü ve mikrovasküler komplikasyonlar kaydedildi.

Bulgular: İki grup arasında yaş (p=0.3), cinsiyet (p=0.1), eğitim durumu (p=0.6), diyabet süresi (p=0.8), insülin tedavisi süresi (p=0.2) ve ortalama insülin dozu (p=0.1) açısından anlamlı fark yoktu. Kullanım kolaylığı (p=0.8), ergonomi (p=0.3), doz seçimi kolaylığı (p=0.6) ve doz skalasını okuma kolaylığı (p=0.3) açısından 2 grup arasında anlamlı farklılık gözlenmedi. Tek kullanımlık kalem grubunda iğne ucu değiştirmeyi “orta derecede zor” olarak değerlendiren hasta sayısı anlamlı olarak daha fazlaydı (p=0.04).

Sonuç: Hastalara verilen tedavi kadar tedavinin uygulanabilirliği ve hasta memnuniyeti de önemlidir. Ancak çalışmamızda, kullanılabilirlik ve hasta memnuniyeti açısından tek kullanımlık veya yeniden kullanılabilir kalemler arasında ciddi bir fark bulunmamıştır.

Anahtar Kelimeler

• Diabetes mellitus
• enjeksiyon
• insülin
• hasta memnuniyeti

Kaynakça

1. 1. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N et al. TURDEP-II Study Group. Twelve- year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28(2):169-80.
2. 2. Hoerger TJ, Segel JE, Gregg EW, Saaddine JB. Is glycemic control improving in U.S. adults? Diabetes Care. 2008;31(1):81-6.
3. 3. García-Pérez LE, Alvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to therapies in patients with type 2 diabetes. Diabetes Therapy. 2013;4(2):175-94.
4. 4. Al-Qazaz HKh, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, Al-Nuri R et al. Diabetes knowledge, medication adherence, and glycemic control among patients with type 2 diabetes. Int J Clin Pharm. 2011;33(6):1028-35.
5. 5. Rhee MK, Slocum W, Ziemer DC, Culler SD, Cook CB, El-Kebbi IM et al. Patient adherence improves glycemic control. Diabetes Educator. 2005;31(2):240-50.
6. 6. Schectman JM, Nadkarni MM, Voss JD. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care. 2002;25(6):1015-21.
7. 7. Kravitz RL, Hays RD, Sherbourne CD, DiMatteo MR, Rogers WH, Ordway L et al. Recall of recommendations and adherence to advice among patients with chronic medical conditions. Arch Intern Med. 1993;153(16):1869-78.
8. 8. Rodbard HW, Jellinger PS, Davidson JA, Einhorn D, Garber AJ, Grunberger G et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocrine Practice. 2009;15(6):540-59.

9. 9. Bonafede MM, Kalsekar A, Pawaskar M, Ruiz KM, Torres AM, Kelly KR et al. Insulin use and persistence in patients with type 2 diabetes adding mealtime insulin to a basal regimen: a retrospective database analysis. BMC Endocrine Disorders. 2011;11(1):1-9.
10. 10. Stewart KM, Wilson MF, Rider JM. Insulin delivery devices. J Pharm Pract. 2004;17(1):20-8.
11. 11. Wewers ME, Lowe NK. A critical review of visual analog scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13(4):227-36.
12. 12. Marcus A. Diabetes care: Insulin delivery in a changing world. Medscape J Med. 2008;10(5):120.
13. 13. Asche CV, Shane-McWhorter L, Raparla S. Health economics and compliance of vials/syringes versus pen devices: a review of the evidence. Diabetes Technol Ther. 2010;12(1):101-8.
14. 14. Coscelli C, Lostiab S, Lunettac M, Nosarid I, Coronele GA. Safety, efficacy, acceptability of a pre-filled insulin pen in diabetic patients over 60 years old. Diabetes Res Clin Pract. 1995;28(3):173-7.
15. 15. Korytkowski M, Bell D, Jacobsen C, Suwannasari R. A multicenter, randomized, open- label, comparative, two-period crossover trial of preference, efficacy and safety profiles of a prefilled, disposable pen and conventional vial/syringe for insulin injection in patients with type 1 or 2 diabetes mellitus. Clin Ther. 2003;25(11): 2836-48.
16. 16. Lee WC, Balu S, Cobden D, Joshi AV, Pashos CL. Medication adherence and the associated health-economic impact among patients with type 2 diabetes mellitus converting to insulin pen therapy: an analysis of third-party managed care claims data. Clin Ther. 2006;28(10):1712-25.
17. 17. Aljahlan M, Lee KC, Toth E. Limited joint mobility in diabetes: Diabetic cheiroarthropathy may be a clue to more serious complications. Postgraduate Medicine. 1999;105(2):99-106.
18. 18. Casanova JE, Casanova JS, Young MJ. Hand function in patients with diabetes mellitus. South Med J. 1991;84(9):1111-3.
19. 19. Aylward GW. Progressive changes in diabetics and their management. Eye. 2005;19(10):1115-8.
20. 20. Asakura T, Seino H. Assessment of dose selection attributes with audible notification in insulin pen devices. Diabetes Technol Ther. 2005;7(4):620-6.
21. 21. Haak T, Edelman S, Walter C, Lecointre B, Spollett G. Comparison of usability and patient preference for the new disposable insulin device Solostar versus FlexPen, lilly disposable pen, and a prototype pen: an open-label study. Clin Ther. 2007;29(4):650-60.
22. 22. Ignaut DA, Schwartz SL, Sarwat S, Murphy HL. Comparative device assessments: Humalog KwikPen compared with vial and syringe and FlexPen. The Diabetes Educator. 2009;35(5):789-98.
23. 23. Klausmann G, Hramiak I, Qvist M, Mikkelsen KH, Guo X. Evaluation of preference for a novel durable insulin pen with memory function among patients with diabetes and health care professionals. Patient Prefer Adherence. 2013;7:285-92.
24. 24. Gnanalingham MG, Newland P, Smith CP. Accuracy and reproducibility of low dose insulin administration using pen-injectors and syringes. Arch Disn Child. 1998;79(1):59-62.
25. 25. Asakura T, Jensen KH. Comparison of intuitiveness, ease of use, and preference in two insulin pens. J Diabetes Sci Technol. 2009;3(2):312-9.
26. 26. Reimer T, Hohberg C, Pfützner AH, Jørgensen C, Jensen KH, Pfützner A. Intuitiveness, instruction time, and patient acceptance of a prefilled insulin delivery device and a reusable insulin delivery device in a randomized, open-label, crossover handling study in patients with type 2 diabetes. Clin Ther. 2008;30(12):2252-62.
27. 27. Shaefer CF. The pen is mightier than the sword. Insulin. 2009;4(3):132-5.
28. 28. Hänel H, Weise A, Sun W, Pfützner JW, Thomé N, Pfützner A. Differences in the dose accuracy of insulin pens. J Diabetes Sci Technol. 2008;2(3):478-81.
29. 29. Yakushiji F, Fujita H, Terayama Y, Yasuda M, Nagasawa, Shimojo M et al. The best insulin injection pen device for caregivers: results of injection trials using five insulin injection devices. Diabetes Technol Ther. 2010;12(2):143-8.