1Medical Affairs, sanofi-aventis, Bridgewater, NJ; and 2International Diabetes Center, Park Nicollet, Minneapolis, MN.
Am J Ther. 2013 Nov-Dec;20(6):694-702. doi: 10.1097/MJT.0b013e318217a5e3.
Insulin is essential for the treatment of type 1 diabetes, and most patients with type 2 diabetes will eventually require insulin for glycemic control. Several barriers contribute to delays in initiating insulin therapy in type 2 diabetes. Furthermore, insulin-treated patients often miss doses or otherwise fail to self-administer their insulin as prescribed, placing themselves at the risk of developing complications. Insulin pens can help overcome barriers to initiating insulin therapy and can facilitate the self-management of diabetes. Compared with the vial and syringe, insulin pens are more accurate, associated with greater adherence, and preferred by patients because of their convenience and ease of use. Large database analyses suggest that insulin pens may reduce the rate of occurrence of hypoglycemic events in patients with type 2 diabetes. Despite higher costs of insulin pens vs vials and syringes, studies suggest little or no increase in total health care costs and decreases in diabetes-related costs associated with reduced health care utilization with pens. Interestingly, the use of insulin pens within the United States lags far behind the use of pens in Europe and Japan. Insulin pens may be disposable or refillable, and some pens have special features [eg, audible clicks, large-dose selector and dial, memory function, half-unit dosing, high dosing (ie, 80 U)] that offer the opportunity to individualize treatment by meeting patients' needs. This review compares available insulin pens, describes strategies to facilitate their usage, and discusses how insulin pens can improve self-management of diabetes while reducing cost.
胰岛素是治疗 1 型糖尿病的必备药物，大多数 2 型糖尿病患者最终也需要胰岛素来控制血糖。有几个障碍导致 2 型糖尿病患者延迟开始胰岛素治疗。此外，接受胰岛素治疗的患者经常错过剂量或未能按照规定自行注射胰岛素，使自己面临发生并发症的风险。胰岛素笔可以帮助克服开始胰岛素治疗的障碍，并促进糖尿病的自我管理。与小瓶和注射器相比，胰岛素笔更准确，与更高的依从性相关，并且由于其便利性和易用性而受到患者的青睐。大型数据库分析表明，胰岛素笔可能会降低 2 型糖尿病患者发生低血糖事件的发生率。尽管胰岛素笔的成本高于小瓶和注射器，但研究表明，总医疗保健费用几乎没有增加，与使用笔减少医疗保健利用率相关的糖尿病相关成本也有所降低。有趣的是，胰岛素笔在美国的使用率远远落后于欧洲和日本。胰岛素笔可以是一次性的或可重复使用的，有些笔具有特殊功能[例如，可听到的咔嗒声、大剂量选择器和拨号盘、记忆功能、半单位剂量、高剂量（即 80U）]，通过满足患者的需求来提供个性化治疗的机会。这篇综述比较了现有的胰岛素笔，描述了促进其使用的策略，并讨论了胰岛素笔如何在降低成本的同时改善糖尿病的自我管理。
