title: Randomized trial on the influence of the length of two insulin pen needles on glycemic control and patient preference in obese patients with diabetes.
abstract: OBJECTIVE
  This study determined the influence of needle length for insulin administration on metabolic control and patient preference in obese patients with diabetes mellitus.
  
  
  METHODS
  In this multicenter, open-label crossover study, insulin pen needles of two different lengths (5 mm and 8 mm) were compared. A total of 130 insulin-treated type 1 and type 2 diabetes patients with a body mass index ≥30 kg/m(2) were randomized, and 126 patients completed the study. Patients started using the 5-mm needle for 3 months, after which they switched to injecting insulin with the 8-mm needle for another 3 months, or vice versa. Hemoglobin A1c (A1C), fructosamine, and 1,5-anhydroglucitol were measured, and self-reported side effects and patient preference were recorded.
  
  
  RESULTS
  No within-group changes were observed with respect to A1C, serum fructosamine, 1,5-anhydroglucitol, hypoglycemic events, bruising, and pain. When data of all 126 subjects were pooled, there was a small, but significant, difference between needle lengths (5-mm, A1C 7.47 ± 0.9%; 8-mm, 7.59 ± 1.0%; P = 0.02). Patients reported less bleeding with the 5-mm needle (P = 0.04) and less insulin leakage from the skin with the 8-mm needle (P = 0.01). There were no significant differences in patient preference, with 46% of the patients preferring the 5-mm needle, 41% the 8-mm needle, and 13% not preferring a particular needle length.
  
  
  CONCLUSIONS
  A 5-mm needle is similar to an 8-mm needle in obese patients with diabetes with respect to metabolic control, injection-related complaints, or patient preference and can be used safely.
authors.affiliation: Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Gillian
authors.initials: G
authors.lastname: Kreugel
authors.forename: Joost C
authors.initials: JC
authors.lastname: Keers
authors.forename: Michiel N
authors.initials: MN
authors.lastname: Kerstens
authors.forename: Bruce H R
authors.initials: BH
authors.lastname: Wolffenbuttel
mesh_terms: D000368:Aged; D015992:Body Mass Index; D018592:Cross-Over Studies; D003847:Deoxyglucose / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D019270:Fructosamine / Q000097:blood; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007279:Injections, Subcutaneous / Q000295:instrumentation; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects; D009426:Netherlands; D009765:Obesity / Q000150:complications*; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D012646:Self Administration
chemical_list: D003847:Deoxyglucose; D019270:Fructosamine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human; C006584:1,5-anhydroglucitol