title: Comparing patient preferences and healthcare provider recommendations with the pen versus vial-and-syringe insulin delivery in patients with type 2 diabetes.
abstract: OBJECTIVE
  This study aimed to examine healthcare provider (HCP) recommendations and patient preferences for the insulin pen versus vial-and-syringe in patients with type 2 diabetes mellitus (T2DM) and to assess clinical end points and safety outcomes.
  
  
  METHODS
  Using a randomized, open-label, crossover design, in total, 405 insulin-naive adults with T2DM from 60 centers received basal insulin glargine in one of two device treatment sequences (2 weeks of pen followed by 2 weeks of vial-and-syringe, or vice versa). The primary end point, patient device preference, was evaluated at Week 4 (end of the crossover period) using the Insulin Injection Preference Questionnaire. Patient preference and HCP recommendation were assessed with one global item and three subscale items (blood glucose control, reluctance to use insulin, and long-term insulin use) using a 5-point scale ranging from 1=not preferred or not recommended to 5=preferred or recommended. Patients were then re-randomized to either pen or vial-and-syringe for further observation (6, 10, and 30 weeks) to evaluate clinical end points (glycosylated hemoglobin [A1C] and fasting blood glucose levels) and safety outcomes (hypoglycemia and adverse events).
  
  
  RESULTS
  Patients reported a significant preference for pens over vial-and-syringe, and HCPs strongly recommended pens over vial-and-syringe (both P<0.001). Consistent response patterns were observed by HCPs and patients for the three subscale items. Fasting blood glucose, A1C levels, and the incidence of hypoglycemia were comparable in the two groups.
  
  
  CONCLUSIONS
  Patients preferred pens over vial-and-syringe, with the pen device also recommended by HCPs, when initiating basal insulin treatment in insulin-naive patients with T2DM.
authors.affiliation: 1 Oregon Health & Science University , Portland, Oregon.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ahmann
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Szeinbach
authors.forename: Jasvinder
authors.initials: J
authors.lastname: Gill
authors.forename: Louise
authors.initials: L
authors.lastname: Traylor
authors.forename: Satish K
authors.initials: SK
authors.lastname: Garg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004209:Disposable Equipment; D016503:Drug Delivery Systems / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous / Q000295:instrumentation; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D057240:Patient Preference / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013594:Syringes
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin