Competency of Prefilled Insulin Pen Usage Among Diabetes Patients in Saudi Arabia: A Cross-sectional Study

Author(s): Besher Akram Sweidan*, Momen Mohammad Al Ajlouni, Asirvatham Alwin Robert, Aus A. Alzaid

Journal Name: Current Diabetes Reviews

Volume 15 , Issue 3 , 2019

Become EABM
Become Reviewer


Background: Correct insulin injection practice is essential for better diabetic control. The aim of this study is to investigate the level of competency of prefilled insulin pen usage (injection technique and storage) among diabetes patients in Saudi Arabia.

Methods: A cross-sectional survey between March 2017 to July 2017 of randomly selected patients with diabetes attending Diabetes Treatment Center, Prince Sultan Military Medical City, Saudi Arabia, who are actively using a prefilled insulin pen, were interviewed to complete a pre-structured questionnaire to assess the competency of using the insulin pen. The contents of the questionnaire addressed the 6 competency components according to manufacturer recommendation (priming, count time, storage, using new needles, a store with no needles, and discard date), background, clinical and metabolic data. Results of the questionnaire were analyzed to identify common pitfalls and were also contrasted with background clinical and metabolic data.

Results: 165 patients with diabetes (aged 14-70yrs) were interviewed for the study and all questioners completed properly. Only 14 (8.5%) patients were following all of the six competency components. Count time 52 (31.6%) was the least followed competency component of the six, whereas discard date and storage of insulin pen were the most followed with 165 (100%) and 159 (96.4%), consecutively. Education was the only significant variable related to the following more than 3 of the competency components, and logistic regression showed the college or higher educated patients to be three times more likely follow more than 3 of the competency components.

Conclusion: The study concluded that majority of patients are either ignoring or unaware of the major components of correct use of prefilled insulin in Saudi Arabia.

Keywords: Prefilled insulin pens, diabetes, diabetes education, diabetes patients, Saudi Arabia, cross-sectional study.

Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5): 1047-53.
Robert AA, Al Dawish MA, Braham R, et al. Type 2 diabetes mellitus in saudi arabia: major challenges and possible solutions. Curr Diabetes Rev 2017; 13(1): 59-64.
Al Dawish MA, Robert AA, Braham R, et al. diabetes mellitus in saudi arabia: a review of the recent literature. Curr Diabetes Rev 2016; 12(4): 359-68.
Bossi AC, Veronesi G, Poerio CS, et al. A prospective study for introducing insulin pens and safety needles in a hospital setting. the SANITHY study. Curr Diabetes Rev 2016; 12(4): 460-7.
Hornquist JO, Wikby A, Andersson PO, Dufva AM. Insulin-pen treatment, quality of life and metabolic control: retrospective intra-group evaluations. Diabetes Res Clin Pract 1990; 10(3): 221-30.
Brunton S. Initiating insulin therapy in type 2 diabetes: benefits of insulin analogs and insulin pens. Diabetes Technol Ther 2008; 10(4): 247-56.
Bhardwaj VR, Metcalfe N, Innes E, Harrison E, Jenkins D. Recurrent diabetic ketoacidosis after changing pen devices for insulin injection. BMJ 2006; 332(7552): 1259-60.
Mitchell VD, Porter K, Beatty SJ. Administration technique and storage of disposable insulin pens reported by patients with diabetes. Diabetes Educ 2012; 38(5): 651-8.
Hofman PL, Derraik JG, Pinto TE, et al. Defining the ideal injection techniques when using 5-mm needles in children and adults. Diabetes Care 2010; 33(9): 1940-4.
Hofman PL, Lawton SA, Peart JM, et al. An angled insertion technique using 6-mm needles markedly reduces the risk of intramuscular injections in children and adolescents. Diabet Med 2007; 24(12): 1400-5.
Bailey TS, Stone JY. A novel pen-based bluetooth-enabled insulin delivery system with insulin dose tracking and advice. Expert Opin Drug Deliv 2017; 14(5): 697-703.
Shah RB, Patel M, Maahs DM, Shah VN. Insulin delivery methods: Past, present and future. Int J Pharm Investig 2016; 6(1): 1-9.
De Coninck C, Frid A, Gaspar R, et al. Results and analysis of the 2008-2009 insulin injection technique questionnaire survey. J Diabetes 2010; 2(3): 168-79.
Karges B, Boehm BO, Karges W. Early hypoglycaemia after accidental intramuscular injection of insulin glargine. Diabet Med 2005; 22(10): 1444-5.
Schaefer MK, Kossover RA, Perz JF. Sharing insulin pens: are you putting patients at risk? Diabetes Care 2013; 36(11): e188-9.
Frid A, Hirsch L, Gaspar R, et al. New injection recommendations for patients with diabetes. Diabetes Metab 2010; 36(Suppl. 2): S3-S18.
Tandon N, Kalra S, Balhara YP, et al. Forum for Injection Technique (FIT), India: The Indian recommendations 2.0, for best practice in Insulin Injection Technique, 2015. Indian J Endocrinol Metab 2015; 19(3): 317-31.
Spollett G, Edelman SV, Mehner P, Walter C, Penfornis A. Improvement of insulin injection technique: examination of current issues and recommendations. Diabetes Educ 2016; 42(4): 379-94.
Ginsberg BH, Parkes JL, Sparacino C. The kinetics of insulin administration by insulin pens. Horm Metab Res 1994; 26(12): 584-7.
Tschiedel B, Almeida O, Redfearn J, Flacke F. Initial experience and evaluation of reusable insulin pen devices among patients with diabetes in emerging countries. Diabetes Ther 2014; 5(2): 545-55.
Ji J, Lou Q. Insulin pen injection technique survey in patients with type 2 diabetes in mainland China in 2010. Curr Med Res Opin 2014; 30(6): 1087-93.
Thurman JE. Insulin pen injection devices for management of patients with type 2 diabetes: considerations based on an endocrinologist’s practical experience in the United States. Endocr Pract 2007; 13(6): 672-8.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Published on: 01 April, 2019
Page: [240 - 246]
Pages: 7
DOI: 10.2174/1573399814666180528081552
Price: $65

Article Metrics

PDF: 50
PRC: 2