Abstract Introduction Insulin-related medication incidents remain a significant patient safety concern. National safety guidance highlights the risk of severe harm from withdrawing insulin from pen devices using syringes, often due to staff unfamiliarity with devices in hospital settings [1,2]. Insulin was found to be one of the most implicated medicines in medication related incidents in our organisation, which suggested our risk mitigations required review and improvements. Aim This mixed-methods study aimed to assess which kinds of insulin were being kept as ward stock across the organisation and explore ward insulin management for a sample of patients. Specific objectives were to discover whether insulin cartridges and pen devices are being held as ward stock on adult wards; to identify ways to optimise access to insulin ward stock; and to gather baseline data on current approaches to insulin management. Methodology A review of all insulins held as ward stock (adult wards) was conducted using reports from the pharmacy computer system. Insulin products stocked in the organisation were mapped against the wards that held them. For insulins available in a vial, pharmacy supply data was analysed over a 6-month period (September 2024-April 2025), to identify usage trends across adult clinical areas. Insulin management was reviewed in general surgical wards over one month (July 2024). Data was collected around insulin storage and administration; evidence of consent and assessment for self-administration from the electronic prescribing system; and patient feedback. Ethics approval was not required; the study was registered locally as a service evaluation. Results Among fifty-eight adult inpatient wards, no standard approach to insulin stock was found. Most areas kept vials of Novorapid® and Actrapid®. Ten ward areas held six different insulins formulations as ward stock in pre-filled pen devices. Four wards stocked Insulatard®, despite its discontinuation, and five areas stocked both vial and pen forms of Novorapid®. For insulins available in a vial, the most supplied insulin not routinely stocked was Lantus®, followed by Humulin I® and Humulin M3®. In the surgical area review (n = 11), insulin was stored in multiple locations including ward fridges (n = 3), unsecured bedside areas (n = 6), and Patient Own Drug (POD) lockers (n = 2). Administration practices ranged from full independent administration (n = 2) to mixed processes involving both nurses and patients (n = 9). No records relating to self-administration were recorded on the electronic prescribing system. The patients who provided feedback (n = 7), most reported frustration regarding their inpatient insulin management (n = 5). Patients who retained control over their insulin management reported greater satisfaction and better blood glucose control (n = 2). Discussion A standardised approach to insulin ward stock should be adopted to reduce variation and enhance safety. Pre-filled insulin pens should be removed from stock and dispensed from pharmacy for individual patients. Lantus®, Humulin I® & Humulin M3® insulins require increased ward stock in certain areas to efficiently meet demand. Findings from our surgical areas highlight the need for policy development and improved governance, particularly relating to the self-administration and management of insulin. This would address inconsistencies and improve patient experience [3].

Are YouTube videos a reliable and quality source for insulin pen injection in children?

Background and AimsIntegration of data from continuous glucose monitoring (CGM) and connected insulin pens allows us to investigate their use to optimise glucose control. This study examines how insulin bolus frequency reported by connected pens and frequency of glucose scans by an intermittently‐scanned continuous glucose monitoring (isCGM) system relate to glycaemic control in a population of real‐world European users.MethodsData from glucose sensors and connected insulin pens were aggregated for LibreView users who integrated their connected pen by January 1, 2024. The most recent 90‐day window with ≥30 days' glucose data and ≥15 days of insulin bolus doses following their integration date was analysed. We stratified users by categories of average isCGM scan frequency: low (<6.1 scans/day), medium (6.1–14.0 scans/day) or high (>14.0 scans/day), and average bolus frequency: low (<3.1 boluses/day), medium (3.1–6.7 boluses/day) or high (>6.7 boluses/day).ResultsData from 10,993 users was available over 80.6 days/user. Median scans/day were 9.3 [6.1–14.0] and median bolus/day was 4.5 [3.1–6.7]. Increased daily scans were associated with greater time in range (TIR) 70–180 mg/dL (3.9–10.0 mmol/L) within each of the low, medium, and high bolus frequency groups. Increased bolus frequency was associated with increased TIR in the lowest scanning frequency group. Similar outcomes were observed for time above range (TAR) and glycaemic variability.ConclusionsWhile glucose monitoring frequency and insulin bolus dosing are both indicators of engagement with diabetes self‐management, higher TIR has a closer association with increased rates of user engagement with isCGM than with increased rates of bolus dosing.

Assessment of insulin pen injection practices and the effectiveness of pharmacist interventions in improving injection technique among patients with diabetes mellitus

Understanding insulin dose deviations in people with type 2 diabetes receiving telemonitoring.

IntroductionThe chronic character of Type 1 Diabetes Mellitus (T1DM) causes patients to be fully aware of the essence and consequences of their illness and to suffer from stigmatisation, tiredness, stress, fear, anxiety and poor mental health.Purpose of the paperThe purpose of this paper is to assess the level of knowledge, stress and acceptance of the illness in young adults with T1DM and to present the impact of various sociodemographic and medical factors on the level of knowledge, stress and acceptance of the illness in young adults with T1DM.Materials and methodsThis study used an original survey and the psychological PSS-10 and AIS questionnaires among young adults with T1DM who had been ill for more than a year. The survey was conducted from 01.08.2023 to 30.11.2024.ResultsThe survey involved 274 young adults aged 18 to 35 years, who had T1DM for 13.4 ± 7.1 years on average. The medians of the test and raw scores for the respondents’ answers to statements in the AIS psychological questionnaire were 18 (17÷19) and 29 (23÷35), respectively, whereas the medians of the raw score and sten scores in the responses given in the PSS-10 psychological questionnaire were 20 (15÷24) and 7 (5÷8), respectively. A negative relationship was confirmed between the level of knowledge and the HbA1c concentration. The survey indicated that women with primary education, being in a relationship, smoking, having hypertension, hypothyroidism and lipohypertrophy, and being treated with multiple daily injections (MDI; automatic insulin pen) had high stress levels. There was a positive relationship between the level of stress experienced by the respondents and their BMI, as well as between the duration of the illness and the number of hyperglycaemic incidents at night. The survey indicated that people with primary education, being single, nonsmoking, not keeping a “paper” self-monitoring journal and having regular nursing and educational appointments at the Diabetes Clinic better accept their illness. The survey confirmed a negative relationship between the level of acceptance of the illness and the HbA1c concentration and hyperglycaemic incidents during the day.ConclusionsThe level of stress experienced by young T1DM patients is high. Young T1DM patients do not accept the illness. Understanding treatment principles helps patients achieve metabolic balance in a significant way. The level of stress, the level of acceptance of the illness doesn’t have relation to the level of knowledge. Contemporary technologies used in T1DM self-monitoring and treatment reduce the level of stress and help patients accept and adapt to the illness. The use of MDI generates a high level of stress in young T1DM patients, and the fact that they do not need to keep a “paper” self-monitoring journal helps them better accept the illness. Educational nurses support young T1DM patients in diabetes therapy and help them accept their illness. Young adults with T1DM need support of psychologists.

This study evaluated whether a stage 4 smart insulin pen (SIP) provides superior glycemic control compared with a traditional insulin pen (TIP) in individuals with intensively insulin-treated diabetes. Forty-two adults with continuous glucose monitoring (CGM), multiple daily insulin injections, and no prior SIP use were included. After diabetes self-management education (DSME), the SIP group (n=21) initiated SIP, whereas the TIP group (n=21) continued their usual regimens. Glycemic metrics were assessed using CGM before and 2 weeks after DSME. Both groups demonstrated significant improvements in glycemic outcomes. However, SIP users exhibited superior improvements in the percentage of time in range, percentage of time below range (%TBR) <70 mg/dL, %TBR <54 mg/dL, and glycemic risk index compared with TIP users (between-group difference [BD] 11.0%, P=0.046; BD -2.6%, P=0.024; BD -0.9%, P=0.027; BD -18.2, P=0.022, respectively). These findings suggest that SIP, with its bolus calculation and CGM integration, is associated with improved glycemic outcomes in adults with intensively insulin-treated diabetes.

ABSTRACT Objectives Vunakizumab (SHR-1314) is a novel IL-17A monoclonal antibody that has demonstrated great efficacy and safety in treating moderate-to-severe plaque psoriasis. This study aimed to evaluate the pharmacokinetics and safety of vunakizumab to healthy subjects following subcutaneous administration via a single 2 mL automatic injection (AI) pen compared to two 1 mL AI pen injections. Methods This study was a randomized, open-label, two-stage, two-sequence crossover design. Participants were randomly assigned to either the 2 mL × 1 AI injection group or the 1 mL × 2 AI injection group. Injection site pain was assessed using a visual analog scale (VAS) at predefined time points. Participants’ preferred dosing method was evaluated 2 weeks post-Day 43. The relative bioavailability was determined based on Cmax and AUC0-28d. Results No significant differences were observed between the two groups in VAS scores, injection site reactions, or the incidence of treatment-related adverse events. The geometric mean ratios for Cmax and AUC0-28d were 109% and 107%, respectively. Conclusion Both injection devices were well-tolerated in terms of safety. Participants preferred a single 2 mL subcutaneous injection over two 1 mL subcutaneous injections. Clinical Trial Registration www.clinicaltrials.gov, identifier: NCT06182384.

IntroductionContinuous glucose monitoring (CGM) provides real-time glucose data for people with diabetes. However, detailed knowledge of its use in daily life remains limited. We aim to investigate the interaction between people with type 1 diabetes (T1D) and their CGM data and the impact of the interaction on glycaemia and diabetes distress.Methods and analysisThis is a two-centre observational study of adults (n=500) with T1D using FreeStyle Libre 2. Over a period of 14 days, participants will continue their regular CGM use, record insulin doses and timing with smart insulin pens, track activity and sleep with an activity tracker, log all food intake in the LibreLink app and answer questions about quality of life and hypoglycaemia two times per day. Before the study period, the participants will complete a survey of 11 validated questionnaires assessing diabetes distress, hypoglycaemia awareness and other patient-reported outcomes (PROs). After the study period, the participants will complete two additional questionnaires assessing diabetes distress and health literacy.The collected data will be used in two substudies with the overall aims of:Substudy 1: to investigate how CGM is used in practice and the impact of the interaction on diabetes distress and glycaemia.Substudy 2: to investigate whether and how CGM functions as a technological substitute for impaired awareness of hypoglycaemia, focusing on alarm data.Endpoints will include CGM metrics, alarm data and PROs.Ethics and disseminationThe Danish Data Protection Agency approved the study (P-2024–15985), and the regional committee on health research ethics has granted an ethical waiver (H-24014662). All participants have signed written informed consent forms before participating. The results will be published in an international peer-reviewed scientific journal by the study investigators and shared via www.clinicaltrials.gov. Participants who agreed to receive information about the study will be sent the results after publication.Trial registration numberClinicalTrials.gov (NCT06453434).

AimsThis observational study investigated changes in glycaemic control in people living with diabetes after initiating a connected insulin pen to administer their bolus insulin in routine clinical practice.Materials and methodsData were collected from adults (≥18 years) with insulin‐treated diabetes who were using a continuous glucose monitoring (CGM) device and started administering bolus insulin using a connected insulin pen. Key glycaemic outcomes were time in range (TIR; 3.9–10.0 mmol/L), time above range (TAR; >10.0 mmol/L), and time below range (TBR; <3.9 and <3.0 mmol/L) in the overall population and for subgroups by country and by baseline TIR for individuals with 3 months of baseline CGM data.ResultsData were included from 86 133 individuals with a mean (standard deviation) age of 43.7 (15.7) years. There were small but statistically significant increases from baseline in TIR at month 3 (1.5%‐points), month 6 (1.4%‐points) and month 12 (1.1%‐points), and statistically significant decreases from baseline in TAR and TBR (<3.9 and <3.0 mmol/L) at month 3, month 6 and month 12. Increases in TIR were largest for those with the lowest baseline TIR (3‐month baseline average of <40% TIR). Increases in TIR were largest in Austria, with an increase in TIR of 4.7% at month 3.ConclusionsThese real‐world data show that glycaemic outcomes improved after connected insulin pen initiation, especially in individuals with the highest unmet need (i.e., lowest baseline TIR). Combining a connected insulin pen with additional support, such as app‐based training or education, may further improve glycaemic control.

BackgroundPeople with type 1 diabetes require ongoing self-management and frequent follow-up care. Digital care models might offer flexible solutions and increased sustainability, and while the clinical opportunities of these care models have been explored, the characteristics of patients inclined to opt for digital care remain unclear.ObjectiveThis study aimed to investigate which selected sociodemographic and disease-related patient characteristics are associated with opting for digital outpatient care among patients with type 1 diabetes.MethodsThis cross-sectional study was conducted at the endocrinology department of Akershus University Hospital in Norway, as part of a larger longitudinal study. Adult patients with type 1 diabetes were eligible to participate and were recruited consecutively. Patients could choose either a novel, mobile health–based, digital, tailored, outpatient care model (DigiDiaS care) or continuation of usual care. DigiDiaS care is delivered via an app comprising a message service; preconsultation questionnaires; options for physical, video, or telephone consultations; an information page; and an e-learning course. Sociodemographic and clinical data were collected from the participants’ medical records and the national diabetes registry. Self-reported data comprised self-management measured using the Patient Activation Measure 13 (PAM-13), diabetes distress (20-item Problem Areas in Diabetes; PAID-20), well-being (World Health Organization-Five Well-Being Index; WHO-5), and health literacy (12-item short version of the European Health Literacy Survey Questionnaire; HLS-19 Q12) questionnaires. We explored group differences and conducted logistic regression to identify factors associated with opting for DigiDiaS care versus usual care.ResultsA total of 237 patients consented to participate in the study, with 185 (78.1%) opting for DigiDiaS care and 52 (21.9%) opting for usual care. The DigiDiaS care group had a statistically significantly shorter duration of diabetes (median 19, range 0-51 years) compared with the usual care group (median 29, range 3-58 years; P<.001); higher proportions of users of insulin pumps than insulin pens for insulin delivery (DigiDiaS care: 74/185, 40%; usual care: 12/185, 23.1%; P=.007), and a lower median well-being care score (DigiDiaS care: median score 60, range 4-96; usual care: median score 68, range 16-100; P=.04). The DigiDiaS care and usual care groups did not differ in sociodemographic variables, presence of late complications from diabetes or comorbidities, self-management, diabetes distress, or health literacy.ConclusionsThis study reveals that most patients with type 1 diabetes choose digital outpatient care when it is offered. Our study suggests that those opting for DigiDiaS care are already familiar with using diabetes-related technology, have a shorter diabetes duration, and have lower well-being. It is essential to understand the characteristics of patients who opt for usual care to ensure high-quality health care services. Further studies should also focus on how the implementation of digital solutions in outpatient care can affect how and if patients use them.International Registered Report Identifier (IRRID)RR2-10.2196/52766

AimsThis study aimed to evaluate the clinical outcomes of switching from disposable insulin delivery pens to reusable insulin pens with a penfill cartridge system for the co-formulation of insulin degludec and insulin aspart (IDegAsp) in patients with type 2 diabetes (T2D) in Türkiye. We assessed the impact on glycemic control to evaluate the sustainability of this transition.MethodsA total of 226 adults with T2D who were initiating or switching to IDegAsp reusable cartridge insulin pens at a tertiary center in Türkiye were followed for 6 months. Data were retrospectively extracted from the medical records at baseline (prior to switching) and at follow-up visits after 3 and 6 months of IDegAsp Penfill reusable cartridges.ResultsInitiating the IDegAsp reusable cartridge insulin pen in patients who previously used basal-bolus, basal, or premixed insulin therapies with disposable insulin pens was associated with a significant reduction in mean glycated hemoglobin (HbA1c) [mean change -1.0% (95% confidence interval (CI) − 2.2 to − 0.20; p < 0.001)], [− 1.4% (95% CI − 2.3 to − 0.4; p < 0.001)], and [− 0.9% (CI − 1.7 to − 0.1; p < 0.001)]. Switching from IDegAsp disposable insulin pens to the reusable system demonstrated noninferior outcomes [− 0.08% (CI − 0.2 to 0.1; p = 0.629)]. The mean total daily insulin dose and body weight were also significantly lower in patients who were switched from basal-bolus insulin, basal insulin or premixed insulin therapies (p < 0.001 and p < 0.001, respectively).ConclusionInitiating or switching to the IDegAsp reusable pen with the insulin cartridge system in a real-world population of people with T2D in Türkiye was associated with improved or maintained glycemic control.

Diabetes Technology and the Older Adult: Clinical Outcomes and Implementation Strategies.

\ Background: Sustainability in healthcare is a relatively new concept that aims to integrate environmental, financial, and social factors. Diabetes care in low socioeconomic communities relies on disposable medical supplies, leading to increased waste. This study aims to propose the application of the (reduce, reuse and recycle) framework in diabetes care to enhance sustainability Subjects and Methods: This study used a mixed-methods approach, including both a literature review and a pilot survey. The literature review included fifty studies focusing on sustainable healthcare practices. A survey was conducted among fifty healthcare professionals and fifty patients to assess their baseline knowledge about practices related to sustainability in healthcare. Results were analyzed to assess similarities or differences between high and low socioeconomic communities Results: The survey revealed that 63% of patients thought treatment costs was the primary barrier to sustainability, while 50% of healthcare providers pointed to limited resources. Both groups emphasized the need for government support and education to enhance sustainability efforts. Reusable insulin pens and eco-friendly packaging were the most viable solutions. Conclusions: Applying sustainability to diabetes care can reduce both environmental and economic burdens. This is particularly challenging in low-resource settings, where cost and infrastructure limitations persist. Policy reforms, education, and innovation to reduce waste is essential to achieve a sustainable healthcare system.

Smart insulin pen after pancreatectomy: a successful strategy for managing type 3c diabetes.

Beyond glycemic metrics: Real-world benefits of connected insulin pens in type 1 diabetes.

This single-arm handling study assessed whether the reusable DuraTouch® pen injector is easy to use and easy to learn how to use in adults with type 1 diabetes (T1D) or type 2 diabetes (T2D) with or without prior pen injector experience. Following a 15-min training session, participants were instructed to independently administer a simulated DuraTouch injection. Of the 100 included participants (91% with T2D, 9% with T1D), 50% had prior pen injector experience. Pen injector-naive participants required more training time than pen injector-experienced participants (median time, 11 vs. 9 min, respectively). Overall, 85% of participants found DuraTouch very easy or extremely easy to use (using the Diabetes Pen Experience Measure), and 87% found it easy or very easy to learn how to use (using the Injection Device Experience and Acceptability questionnaire). DuraTouch may be a viable pen injector alternative for individuals with diabetes, irrespective of prior pen injector experience.

Objective: To analyze the affective response of parents of type 1diabetes children in a developing country like Pakistan.Methodology: One-year cross-sectional study, utilizing questionnaires, analyzed the economic and psychosocial aspects of newly diagnosed type 1 diabetes (T1D) parents, presenting in a tertiary care unit.Results: Seventy-nine parents were part of the study. The monthly family income of 82% parents was less than 50,000/- rupees. 78% parents felt shocked and depressed, 14% experienced guilt and 8% were in denial after diagnosis. 93% did not accept injectable insulin as first line of treatment and wanted to try other treatments like homeopathic medicine because of financial constraints, pen prick fear for monitoring blood glucose and insulin injections for treatment. 83% parents concern was affordability of glucose strips and insulin pens and asked for complete financial support for management of their type 1 daibetes child.Parents showed grave apprehensions about life expectancy and long-term medical complications. 81% were apprehensive about schooling, 8% about their marriage and 3% about future career and jobs. 69% parents asked about inheritance of the disease and chances in siblings.Conclusion: Parents are prone to psychosocial affects with depression being the most prevalent followed by guilt and denial. The most stressing aspects were injections and regular monitoring pricks fear. Affordability of monitoring strips and insulin pens was also a stressor along with schooling and physical activities.Key words: Affective response, Chronic illness, Insulin pens, Stress, T1D.

Insulin pens are widely used by people with diabetes for insulin application. Most often ready-to-use pens are used; however, disposal of these pens generates a considerable amount of plastic waste. Until now such pens have almost always been disposed of with household waste. We recommend to establish a nationwide recycling process for insulin pens in Germany over the next few years (PenDE). Collecting and sorting of the finished pens have several facets, which are discussed in this commentary. It is primarily about recycling the actual product, ie, the finished pens, and not their packaging and packaging inserts. Such a project is only possible in close cooperation with the insulin pen manufacturers. The goal is to establish material cycles, ie, multiple use of materials such as recycled plastic.

This study assessed and compared the knowledge, attitude and Practice of insulin use and devices among diabetic patients and physicians in the Kenyatta National Hospital (KNH) diabetic clinic and Presbyterian Church of East Africa Kikuyu Hospital (PKH) diabetic clinics. A multi-site, cross-sectional study design was adopted with the use of questionnaires to gather data. The sample size was determined using the Cochran formula, and a total of 300 participants were included in the study through consecutive sampling. The study was conducted at the pharmacies dedicated to serving the diabetic clinics in KNH and PKH for 3 months each, or until the estimated sample size was attained. Data was coded and cleaned using Microsoft Excel and analysed using STATA version 14. Descriptive and inferential data analysis were done with the level of significance set at 0.05. The knowledge and practice scores were dichotomised, and logistic regression was utilised to assess the predictors of knowledge and Practice. More PKH patients knew about insulin pens compared to KNH patients (82.7% versus 42.7%). More PKH patients were on insulin pens (40.0% versus 22.7%). Almost all PKH patients primed their pens before use (97% versus 62%). Both facilities had poor practices among diabetics, which included a low frequency of replacing insulin needles (PKH 72% versus KNH 77%). Overall, physicians in both facilities showed good knowledge, attitude, and practice toward insulin pens. Patient attending PKH demonstrated better knowledge and Practice towards insulin pens compared to KNH. Training is needed to address poor practices.