Analysis of insulin pen devices for the treatment of diabetes mellitus.

Insulin pen devices allow for accurate, flexible, and less complicated delivery of insulin for the treatment of diabetes mellitus. These devices permit small dose administration, and can be used by patients with limited dexterity and visual impairment. These characteristics may prove beneficial when considering their usefulness. The article by Hanel et al. in this issue of Journal of Diabetes Science and Technology clearly points out that the OptiClik reusable pen may underdose insulin early after cartridge replacement unless properly primed. Insulin pens clearly offer several advantages over traditional vials and syringes. However, patients must be well educated in their use, with continued communication between them and their health care provider to enable good glycemic control.

Insulin pen injection devices for management of patients with type 2 diabetes: considerations based on an endocrinologist's practical experience in the United States.

OBJECTIVE: To review the features of several insulin pens currently available in the United States, discuss the validity of concerns about certain pen devices, and provide specific training information for clinicians to increase the accuracy of insulin administration and patient satisfaction with the use of insulin pens. METHODS: The published literature on insulin pens and Internet-available, product-specific information are reviewed. In addition, special practical considerations regarding insulin pen selection based on personal experience in a high-volume endocrinology practice are high-lighted by presentation of case vignettes. RESULTS: For some patients with diabetes, the need for performance of self-injection can be a barrier to acceptance of insulin therapy. Insulin pen devices provide a delivery option that may be more acceptable and more convenient to use in comparison with traditional vials and syringes and thus may promote patient compliance, which can enhance the ability to achieve and maintain glycemic control. When choosing a specific insulin pen for an individual patient, the clinician should consider the patient's insulin regimen, lifestyle, and factors that may affect the ability to use a particular device, such as motor dexterity and visual acuity. CONCLUSION: Insulin pens offer convenience and can potentially increase patient satisfaction and compliance with therapy. Because certain characteristics of a given insulin pen may make it preferable for specific patients, it is important for clinicians to be aware of individual needs. Provision of thorough training for patients in the correct use of insulin pens is important because user error can affect pen performance and accuracy of the dose administered. Manufacturers should be notified of any recurring problems.

The role of thiazolidinediones in the treatment of patients with type 2 diabetes mellitus.

Diabetes mellitus is a significant and growing health concern worldwide. Unfortunately, type 2 diabetes mellitus is generally under-managed, and this may explain the increasing prevalence of diabetic complications throughout the world. The introduction of newer classes of antihyperglycemic agents should enhance the ability of clinicians to achieve optimal blood glucose control. One recent addition to the pharmacologic armamentarium is the thiazolidinedione class. The main effect of thiazolidinediones is amelioration of insulin resistance. These agents may also preserve beta-cell function, although evidence in favor of this effect is still inconclusive. The mechanism of action of thiazolidinediones is not completely understood. Similarly, the current state of knowledge cannot explain the differences in the lipid effects of pioglitazone and rosiglitazone. Thiazolidinediones are commonly used as add-on therapy for those requiring large daily doses of insulin therapy, or in addition to sulfonylurea agents and metformin for those reluctant to start insulin therapy. The potential role of thiazolidinediones as first-line therapy is now emerging. It is possible that in certain subgroups, particularly patients with renal failure, elderly individuals or those with corticosteroid-induced diabetes mellitus, the use of thiazolidinediones as a first-line therapy is justifiable. However, the lack of a long-term safety record, and the cost, would limit the widespread acceptance of this class of agents as first-line therapy.