title: Low discomfort and pain associated with intensified insulin therapy in children and adolescents.
abstract: OBJECTIVE
  Discomfort during insulin injection and self-monitoring of blood glucose (SMBG) is a potential obstacle in diabetes therapy, but its prevalence and extent in relation to clinical variables is uncertain.
  
  
  METHODS
  We prospectively assessed treatment-associated discomfort and pain in an unselected cohort of patients (60 boys and 52 girls; mean age 14.6+/-3.0 years, mean A1C 8.0+/-1.4%) with type 1 diabetes and multiple daily self-injections of insulin, using visual analogue/verbal rating scales (range, 0-10) and a six-item questionnaire.
  
  
  RESULTS
  Pain during insulin injection was absent to very low in 91.9% of patients, and its intensity was independent of age, gender, diabetes duration, current A1C, injection volume, or type of insulin. Injection was more unpleasant than SMBG in 64.2% of patients (mean difference of pain score, 1.0+/-1.7, p<0.0001). Injection into the upper arm was less painful than into the thigh and abdomen. Surprisingly, painlessness of injection and SMBG was not judged an important treatment goal by 22.0 and 32.9% of patients, respectively. Logistic difficulties (41.2% of responses) and time requirements (23.8%), but not pain (10.1%), were considered most relevant problems.
  
  
  CONCLUSIONS
  In young patients with access to optimized diabetes care, pain during insulin injection and SMBG is infrequent or mild, and not widely perceived as problematic, thus encouraging the use of multiple daily injection treatment.
authors.affiliation: Department of Pediatrics, Division of Paediatric Endocrinology and Diabetes, University of Ulm, Eythstr. 24, D-89075 Ulm, Germany. beate.karges@uniklinik-ulm.de
authors.forename: B
authors.initials: B
authors.lastname: Karges
authors.forename: R
authors.initials: R
authors.lastname: Muche
authors.forename: M
authors.initials: M
authors.lastname: Moritz
authors.forename: I
authors.initials: I
authors.lastname: Riegger
authors.forename: K-M
authors.initials: KM
authors.lastname: Debatin
authors.forename: E
authors.initials: E
authors.lastname: Heinze
authors.forename: M
authors.initials: M
authors.lastname: Wabitsch
authors.forename: W
authors.initials: W
authors.lastname: Karges
mesh_terms: D000293:Adolescent; D015190:Blood Glucose Self-Monitoring / Q000009:adverse effects; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000523:psychology; D010147:Pain Measurement; D010349:Patient Compliance; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin