Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment

Abstract

Injectable treatments, such as glucagon-like peptide-1 receptor agonists and insulin, are options for the pharmacologic treatment of type 2 diabetes. Numerous barriers lead to delay in initiating injectable treatment, which, in turn, may lead to inadequate glycemic control and increased risk of diabetes-related complications, underscoring the need to understand and address these barriers. Barriers to the initiation of injectable therapy, strategies to mitigate barriers, and information about needle attributes and their relation to needle pain are reviewed on the basis of published literature retrieval and our clinical experience. Barriers to the initiation of injectable therapy originate from both patients and practitioners. Anxiety about and fear of injection-associated pain has been estimated to affect approximately 30%–50% of patients before the initiation of diabetes education interventions. Advances in needle design have minimized the pain associated with injections, and recent data suggest that actual pain and bleeding associated with various needle gauges (21-gauge to 31-gauge) are mild. Other barriers include concerns about the ability to handle injectable therapy, concerns about treatment side effects, and impacts on quality of life. Practitioners can help to mitigate barriers to injectable treatment for type 2 diabetes by understanding patient perceptions, improving education, and setting realistic expectations about therapy. Strategies for minimizing injection-associated fear and anxiety include a combination of assessment, appropriate needle selection, patient education, behavioral interventions, and monitoring.

Keywords:

• type 2 diabetes
• injection
• needle
• anxiety
• fear

Acknowledgments

Lisa M Klumpp Callan, Robert Schupp, and Mary Hines of inScience Communications, Springer Healthcare, provided medical writing support funded by Bristol-Myers Squibb and AstraZeneca. Authors would like to thank Hiep Nguyen of AstraZeneca for his review of the manuscript.

Disclosure

The development of this manuscript was supported by Bristol-Myers Squibb and AstraZeneca.

Davida F Kruger has served on advisory boards for Novo Nordisk, Abbott Laboratories, Eli Lilly and Company, Sanofi-Aventis, Janssen Pharmaceuticals, Boehringer Ingelheim, DexCom, and Halozyme, has participated in speakers’ bureaus for Janssen Pharmaceuticals, Valeritas, and Bristol-Myers Squibb/AstraZeneca, and has received research/grant support from Bristol-Myers Squibb/AstraZeneca, Eli Lilly and Company, Halozyme, Novo Nordisk, and the Hemsley Foundation. A portion of her salary and benefits are provided by the National Institutes of Health. Phil Estepa was an employee of AstraZeneca at the time the work was completed. Susan LaRue was an employee of AstraZeneca at the time the work was completed and a former employee of Amylin Pharmaceuticals.

The authors report no other conflicts of interest in this work.