title: Comparison between shorter straight and thinner microtapered insulin injection needles.
abstract: BACKGROUND
  Many diabetes patients who require insulin perform multiple subcutaneous injections every day that often cause pain, discomfort, and anxiety. We compared efficacy (glycemic control) and patient preference for two types of needle: a shorter straight needle (32 gauge×4 mm, straight wall; Nippon Becton Dickinson Co., Ltd., Tokyo, Japan; hereafter referred to as BD32S4) and a thinner microtapered needle (33-gauge tip and 28-gauge base×5 mm, double-tapered wall; Terumo Corp., Tokyo, Japan; hereafter referred to as TR33T5) in a single-center study.
  
  
  METHODS
  Eighty-four patients with diabetes were enrolled in a randomized, open-label crossover trial. The patients injected their usual insulin dosage with one type of needle for 4 weeks and then switched to the other type for the next 4 weeks. The serum glycated albumin level was measured before and after each 4-week period. Each patient assessed pain during injection on a 150-mm visual analog scale (VAS). Needle preference, perceptions of handling, and acceptance were assessed by the patients, who completed a questionnaire after using each type of needle for 4 weeks.
  
  
  RESULTS
  In total, 79 patients completed the study. There was no difference of glycemic control between the two needles. The mean VAS score was -14.5 mm (95% confidence interval, -20.9, -8.0 mm), indicating that the patients perceived less pain with the BD32S4 needle. In the overall evaluation, a significantly higher percentage of patients selected the BD32S4 as the better needle compared with the TR33T5 (60.3% vs. 19.2%; P<0.0001).
  
  
  CONCLUSIONS
  The BD32S4 needle was more highly evaluated and was preferred by the patients with respect to pain during injection, usability, and visual impression, without having a negative impact on glycemic control. The overall preference of patients for the shorter needle in this study suggests that needle length may be one of the major contributing factors for patients' comfort in insulin injection, although the other relevant factors of needles still need to be considered.
authors.affiliation: Department of Internal Medicine, Division of Metabolism and Endocrinology, St. Marianna University School of Medicine , Kawasaki, Japan. ynagai@marianna-u.ac.jp
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Nagai
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ohshige
authors.forename: Kaori
authors.initials: K
authors.lastname: Arai
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Yukiyoshi
authors.initials: Y
authors.lastname: Sada
authors.forename: Shintaro
authors.initials: S
authors.lastname: Ohmori
authors.forename: Kentaro
authors.initials: K
authors.lastname: Furukawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kawata
authors.forename: Akio
authors.initials: A
authors.lastname: Ohta
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D016503:Drug Delivery Systems / Q000295:instrumentation*; D005260:Female; D017127:Glycation End Products, Advanced; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D012646:Self Administration; D012709:Serum Albumin / Q000032:analysis; D000093423:Glycated Serum Albumin
chemical_list: D017127:Glycation End Products, Advanced; D007004:Hypoglycemic Agents; D007328:Insulin; D012709:Serum Albumin; D000093423:Glycated Serum Albumin