title: A comparison of insulin injection needles on patients' perceptions of pain, handling, and acceptability: a randomized, open-label, crossover study in subjects with diabetes.
abstract: BACKGROUND
  For some diabetes patients, subcutaneous injections are associated with pain, discomfort, and anxiety. We compared overall preferences of two needle types: NovoFine((R)) 32-gauge tip x 6 mm and NovoFine 30-gauge x 8 mm, when used with the FlexPen((R)) injection device (all from Novo Nordisk A/S [Copenhagen, Denmark] and Novo Nordisk Ltd. [Crawley, UK]).
  
  
  METHODS
  In this randomized, open-label, two-period, crossover trial in 119 insulin-treated patients with type 1 (22%) or 2 diabetes, patients injected their usual insulin with one needle type followed by the alternative, each for 7-14 days. Needle preference and perceptions of pain, handling, and acceptance were assessed using a questionnaire after use of each needle.
  
  
  RESULTS
  Overall, 58% preferred the NovoFine 32-gauge tip, 26% preferred NovoFine 30-gauge tip, while 16% had no preference (P < 0.001 between needles). Subjects injecting </=40 or >40 (I)U/day and two or fewer or more than two injections/day all preferred NovoFine 32-gauge tip over NovoFine 30-gauge tip (all P < 0.05). Little or no pain (<5 mm on a 100-mm Visual Analog Scale) was experienced by 57% of subjects when using NovoFine 32-gauge tip and by 40% when using NovoFine 30-gauge tip. More subjects found the injection button easier to press with NovoFine 30-gauge tip (P < 0.01). Responses for ease of insertion, needle sharpness, and performance favored the NovoFine 32-gauge tip; ease of pushing insulin out through the needle favored NovoFine 30-gauge tip. One person for each needle type reported bleeding/bruising at the injection site.
  
  
  CONCLUSIONS
  NovoFine 32-gauge tip x 6 mm needles are a viable alternative to NovoFine 30-gauge tip x 8 mm needles for people administering daily insulin injections.
authors.affiliation: St. John's Hospital, Livingston, United Kingdom. maureen.mckay@wlt.soct.nhs.uk
authors.forename: Maureen
authors.initials: M
authors.lastname: McKay
authors.forename: Gerhard
authors.initials: G
authors.lastname: Compion
authors.forename: Lene
authors.initials: L
authors.lastname: Lytzen
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects* / Q000379:methods; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects*; D010146:Pain / Q000209:etiology* / Q000523:psychology; D010465:Perception; D011795:Surveys and Questionnaires; D013848:Thigh; D006113:United Kingdom
chemical_list: D007328:Insulin