Comparison of simplicity, convenience, safety, and cost-effectiveness between use of insulin pen devices and disposable plastic syringes by patients with type 2 diabetes mellitus: a cross-sectional study from Bangladesh.

INTRODUCTION: Insulin pen devices and disposable plastic insulin syringes are two common tools for insulin administration. This study aims to compare the simplicity, convenience, safety, and cost-effectiveness of insulin pens versus syringe devices in patients with type 2 diabetes mellitus (T2DM). METHODS: A cross-sectional study was conducted at 14 diabetes clinics throughout Bangladesh from November 2021 to April 2022 among adults with T2DM injecting insulin by pen devices or disposable insulin syringes at least once a day for at least one year by purposive sampling. The simplicity, convenience, and safety of insulin devices were assessed using a structured questionnaire, and the study subjects were scored based on their answers; higher scores indicated a poorer response. Total scores for simplicity, convenience, and safety were obtained by adding the scores for relevant components. Their average monthly medical expense and cost of insulin therapy were recorded. The median values of the total scores and monthly expenses were compared between pen devices and disposable syringe users. RESULTS: 737 subjects were evaluated; 406 were pen users, and 331 were vial syringe users. The pen users had lower median scores for simplicity [6.0 (5.0-8.0) vs. 7.0 (5.0-9.0), p = 0.002], convenience [4.0 (3.0-6.0) vs. 5.0 (4.0-6.0), p < 0.001], and safety [7.0 (6.0-8.0) vs. 7.0 (6.0-9.0), p = 0.008] than vial syringe users. Pen devices were more expensive than vial syringes in terms of average medical expense per month [BDT 5000 (3500-7000) vs. 3000 (2000-5000), p < 0.001], the total cost of insulin therapy per month [BDT 2000 (1500-3000) vs. 1200 (800-1700), p < 0.001] and cost per unit of insulin used [BDT 2.08 (1.39-2.78) vs. 0.96 (0.64-1.39), p < 0.001]. Non-significant differences in favor of pens were observed in HbA1c levels [8.7 (7.8-10) vs. 8.9 (7.9-10)%, p = 0.607] and proportions of subjects having HbA1c < 7% (6.9 vs. 6.3%, p = 0.991). CONCLUSION: Insulin pens are simpler, more convenient, and safe but more expensive than vial syringes. Glycemic control is comparable between pen and syringe users. Long-term follow-up studies are needed to determine the clinical and economic impacts of such benefits of insulin pens.

Economic Burden of Severe Hypoglycemia Among Patients With Diabetes Mellitus.

BACKGROUND: Bangladesh is anticipated to have the eighth-highest number of diabetic patients within the next 15 years. Approximately one-fifth of adult diabetes patients reside in Southeast Asian nations. This study aimed to find out the economic burden of extreme hypoglycemia on diabetic sufferers in Bangladesh. METHODS: A cross-sectional study was carried out amongst 164 Type 2 Diabetes sufferers admitted due to extreme hypoglycemia within 15 months at BIRDEM in Dhaka to decide if they have the impact of extreme hypoglycemia on the cost of illness. The cost was once expressed in BDT. RESULTS: Direct medical cost (37058) and direct non-medical cost (5261) was estimated during the study. Among the direct medical cost, hospital cost was 17735, physician cost was 5745, nonmedical transport cost was 1802, and attendant cost was 3459. The total cost was 48743 BDT (€617) for each severe hypoglycemic event leading to hospitalization, and 6.4244 BDT (€82.4) would be the indirect cost of reduced productivity from spending 5.8 days (46.4 hours) in the hospital. CONCLUSION: The analysis indicates that hypoglycemia has a significant negative influence on the cost and reduces the work output of diabetics.