Simplicity, safety, and acceptability of insulin pen use versus the conventional vial/syringe device in patients with type 1 and type 2 diabetes mellitus in Lebanon

Figures & data

Table 1 Baseline demographic percentages of the 74 patients

Demographics	Insulin pen	Conventional insulin device
Sex
Female	29.7%	21.6%
Male	28.4%	20.3%
Age (years)
10–20	0.0%	0.0%
21–30	5.4%	0.0%
31–40	2.7%	2.7%
41–60	23.0%	13.5%
<60	27.0%	25.7%
BMI
Normal	14.9%	9.5%
Overweight	23.0%	24.3%
Obese	20.3%	8.1%
Diabetes type
Type 1	4.1%	2.7%
Type 2	54.1%	39.2%
Diabetes duration (years)
1–5	6.8%	5.4%
6–10	12.2%	0.0%
11–20	20.3%	14.9%
<20	18.9%	21.6%
Insulin use duration (years)
1–5	20.3%	5.4%
6–10	35.1%	24.3%
11–20	2.7%	9.5%
<20	0.0%	2.7%
Insulin units per day
10–20	21.6%	5.4%
21–30	9.5%	9.5%
31–40	10.8%	8.1%
41–50	8.1%	13.5%
<50	8.1%	5.4%
Other oral hypoglycemic
Secretagogues	12.2%	16.2%
Other antidiabetic	45.9%	25.7%
Insulin injection frequency/day
Once	21.6%	10.8%
Twice	17.6%	20.3%
Other	18.9%	10.8%
HbA1c monitoring frequency
Every 3 months	10.8%	10.8%
Every 6 months	32.4%	16.2%
<6 months	12.2%	14.9%
NA	2.7%	0.0%
Comorbidities
Others	40.5%	23.0%
Stroke/IHD	17.6%	18.9%

Abbreviations: BMI, body mass index; IHD, ischemic heart disease; NA, not available.

Table 2 Correlations

Type	All patients	Pen users	Conventional users
Relationship between ease of use and duration of insulin use
Correlation	−0.18	−0.53	−0.02
P-value	0.292	0.042	0.921
Relationship between age and reading the scale
Correlation	0.37	0.44	0.20
P-value	0.028	0.044	0.473
Relationship between hypoglycemia and secretagogues
Correlation	0.08	0.17	0.39
P-value	0.647	0.457	0.152
Relationship between hypoglycemia and age
Correlation	0.36	0.34	0.39
P-value	0.029	0.135	0.152
Relationship between bruises and stroke/IHD
Correlation	0.17	0.13	0.18
P-value	0.333	0.560	0.510
Relationship between bruises and site rotation
Correlation	0.12	0.14	0.04
P-value	0.477	0.552	0.887

Abbreviation: IHD, ischemic heart disease.

Table 3 Safety–simplicity (SS) factors

Binary correlation between pen and conventional methods and SS factors
SS factors	Pain perception	Bruises	Hypoglycemia	Ease of use	Reading the scale
Correlation	54%	30%	0%	55%	35%
P-value	0.001	0.073	1	0	0.038
Logistic regression analysis for SS factors; G (−2 log likelihood): 21.510
SS factors	Pain perception	Bruises	Hypoglycemia	Ease of use	Reading the scale	Constant
Coefficient	3.98	2.14	−2.20	5.32	0.97	−5.67
Standard error	1.58	1.39	1.73	2.23	1.42	2.27
P-value	0.01	0.12	0.20	0.20	0.49	0.01
Logistic regression analysis for SS factors; G (−2 log likelihood): 23.553
SS factors	Pain perception	Bruises	Ease of use	Constant
Coefficient	3.33	1.53	4.32	−5.40
Standard error	1.26	1.10	1.62	1.94
P-value	0.008	0.164	0.008	0.005

Note: G: most used indicator in logistic regression to quantify the likelihood.

Table 4 Administration procedures

Percentage of correct administration procedures: comparison between insulin pen and conventional users
Administration proceduresa	A	B	C	D	E	F	G	H	I
Pen	38%	52%	52%	48%	24%	0%	19%	24%	86%
Conventional	100%	53%	33%	53%	40%	40%	40%	53%	40%
P-value	0	0.96	0.27	0.74	0.31	0	0.18	0.07	0
Factor analysis of the administration procedures for insulin pen and conventional users
Administration proceduresa	A	B	C	D	E	F	G	H	I
Correlation	−0.64	−0.01	0.19	−0.06	−0.17	−0.53	−0.23	−0.30	0.48
P-value	0	0.957	0.27	0.744	0.31	0.0001	0.176	0.072	0.0003
Logistic regression analysis of administration procedures
Administration proceduresa	A	B	C	D	E	F	G	H	Constant
Coefficient	−38.42	−0.53	19.04	−0.53	0.53	−38.48	−15.03	−22.46	38.95
Standard error	12.33	1.53	8.45	1.53	1.53	15.33	47.31	45.84	12.33
P-value	1	0.73	1	0.73	0.73	1	1	1	1

Notes:

a A: storage. B: method of shaking. C: angle of administration. D: rotating the site of injection. E: cleaning the site of administration. F: examining the suspension before use. G: using a new needle for every injection. H: throwing away needle directly after injection. I: releasing trapped air from vial/syringe (for conventional device) or hearing the click (for pen).

Figure S1 Conventional insulin/vial users questionnaire.

Abbreviations: BMI, body mass index; IHD, ischemic heart disease; M, months; SBGM, self blood glucose monitoring; SS, sliding scale; SU, sulfonylureas.

Figure S2 Insulin Pen users questionnaire.

Abbreviations: BMI, body mass index; IHD, ischemic heart disease; M, months; SBGM, self blood glucose monitoring; SS, sliding scale; SU, sulfonylureas.