Pen Devices for Insulin Self-Administration Compared With Needle and Vial: Systematic Review of the Literature and Meta-Analysis - PubMed (original) (raw)

Review

. 2016 Jun 28;10(4):959-66.

doi: 10.1177/1932296816633721. Print 2016 Jul.

Julián Esteban Barahona-Correa 1, Diana Marcela Romero-Alvernia 1, Sebastián Gil-Tamayo 1, Camilo Castañeda-Cardona 2, Juan Gabriel Bayona 1, Juan José Triana 1, Andrés Felipe Laserna 1, Miguel Mejía-Torres 1, Paula Restrepo-Jimenez 1, Juliana Jimenez-Zapata 1, Diego Rosselli 3

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Review

Pen Devices for Insulin Self-Administration Compared With Needle and Vial: Systematic Review of the Literature and Meta-Analysis

Pieralessandro Lasalvia et al. J Diabetes Sci Technol. 2016.

Abstract

Objectives: Pen devices offer advantages compared with vial and syringe (VaS). The purpose of this article was to evaluate efficacy of pen devices compared to VaS.

Methods: A systematic review of literature was performed in 8 different databases. References were independently screened and selected. Primary observational or experimental studies comparing pen devices with VaS for insulin administrations were included. Studies on specific populations were excluded. Risk of bias was evaluated using appropriate tools. Data on glycosylated hemoglobin (HbA1c), hypoglycemia, adherence, persistence, patient preference, and quality of life (QOL) were collected. Meta-analysis was performed when appropriate. Heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses of the available data was done.

Results: In all, 10 348 articles were screened. A total of 17 studies were finally selected: 7 experimental and 10 analytical. The populations of the included articles were mainly composed of adults with type 2 diabetes mellitus. Important risk of bias was found in all of the articles, particularly experimental studies. Meta-analyses were performed for HbA1c, hypoglycemia, adherence and persistence. Pen device showed better results in mean HbA1c change, patients with hypoglycemia, adherence and persistence compared to VaS. No difference was observed in number of patients achieving <7% HbA1c. Preference studies showed a tendency favoring pen devices, however nonvalidated tools were used. One QoL study showed improvements in some subscales of SF-36.

Conclusions: There is evidence that pen devices offer benefits in clinical and, less clearly, patient-reported outcomes compared to VaS for insulin administration. However, these results should be taken with caution.

Keywords: diabetes mellitus; equipment and supplies; glycosylated; hemoglobin A; insulin; medication adherence; patient preference.

© 2016 Diabetes Technology Society.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Figure 1.

Flow chart or literature search and article selection.

Figure 2.

Figure 2.

Forest plots of meta-analysis for the comparisons between pen devices and vial and syringe (VaS). (A) Percentage of patients achieving HbA1c<7% at 12 months. (B) Mean hBA1c change at 12 months. (C) Mean HbA1c change at 12 months, only studies with insulin-naïve patients. (D) Percentage of patients suffering at least 1 episode of hypoglycemia after 12 months. (E) Mean change for medication possession ratio (MPR) after 12 months. (F) Percentage of persistent patients after 12 months.

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