Evaluation of Diabetic Quality of Life Among Insulin Requiring Patients Shifted to Injection by Insulin Pen

To evaluate the diabetic quality of life (QOL), satisfaction and acceptance of insulin injection by insulin pen device, fifty insulin-treated diabetics (28 IDD and NIDD; age 42. I + 5.6 years; range 30-50) satisfactorily controlled on two injections of mixed insulin (HbAlc < 9%) are randomized into two groups. Group “A” (n = 32; 16M:16F) was shifted to the same dose of premixed insulin injection by insulin pen, while group “B” (n = 18; 9M:9F) served as a control group, continuing insulin injection by conventional syringe and needle. Over 3 months study period, two sets of questionnaires-proved to have good test re-test reliability were used to evaluate patient satisfaction and QOL. Metabolic control was assessed by measuring the levels of HBAl,. Insulin pen improved the QOL, where a significant difference was reported in the pen treated group after the 3 months trial period (23.35 + 9.1 vs. I I.65 + 3.7; ~~0.01) as well as on comparing this group versus the control group (18.61 + 6.4 vs. 11.65 + 3.7; p<O.O5). The results show that insulin pen proved to be more convenient, reliable with minimal mechanical problems, giving accurate dose, adding a difference to the patient’s life and that most of the patients are feeling less conspicuous carrying the insulin pen. Although there was no significant difference in glycaemic control after the usage of the pen injection device (HbAlc 7.5 + 1.1 vs. 7.4 + l.O), the insulin pen, in the scope of its betterment of the diabtic QOL, is highly recommended for young, motivated insulin treated diabetics with less than 36 unit per injection. Introduction Insulin pen (dial a dose cartridge injector) was developed so as to deliver short-acting intermediate and pre-mixed insulin in accurate dosing to such diabetics requiring less than 36 unit of insulin per injection as an alternate to conventional syringe and needle. The pen was originally invented to facilitate and simplify the injection of soluble insulin to the IDD patients on intensified regimen of soluble insulin therapy. The development of such injection devices has not only facilitated multiple daily insulin injections but has also greatly increased acceptance of this type of insulin strategy. As a result, the advantages of insulin injection by insulin pen can be also utilized by NIDD patients. Difficulties arise when therapy is increased from I to 2 or more injections per day. In addition, errors in filling and reading syringes have to be considered in patients with visual impairment and in elderly diabetics with poor manual dexterity (Zeumzem et al., 1988). In a study on insulin pen and intermedi::te acting insulin penfill, the investigators reported that several patients stated that injections were less painful than syringe and needle, although the outer diameter and length of the needle were identical. Most of the patients studied reported as well a feeling of well-being while on pen treatment suggesting that insulin penfill system relieves some of the burdens of the daily life for insulin dependent diabetics (Kolendorfet al., 1988). Trials of using the insulin pen for delivery of pre-mixed insulin revealed that it improved the compliance of the patients to the treatment, achieving the same glycaemic control as that of insulin mix at ratio ranging from 20:80 to