SPECIAL STUDY Reducedpain perception with an automatic needle insertion device

Discussion Pain perception The patients perceived significantly less pain with PenMatem (Figure 3). Although the difference in mean values was small (5 mm on the V A S ) , such a difference can be a significant factor for patients who are afraid of needles and lack confidence in self- injection. Hanas and Ludvigsson* found most subjects did not find their current method of insulin injection particularly painful (most scores falling below 20 mm on the 100 mm VAS), but around 20% of patients reported scores of 20-100 mm, with 9% scoring over 50 mm. There was a sig- nificant correlation between VAS scores for pain and for fear of needles. Similarly, Lee5 found the average pain score using an insulin pen injector was less than 10 mm on a 100 mm VAS. As PenMaterM is likely to be par- ticularly useful among those patients who are afraid of needles, a comparison of the pain scores with PenMate" and NovoPena3 among patients who tend to find injections painful may reveal even greater differences than shown in this study. It is of interest, therefore, that the maximal pain scores obtained with PenMaterM (48.4 mm) were considerably lower than those with Novo- Pens3 (73.0 mm). The questionnaires also indicated that injecting with PenMaterM is less painful, more patients reporting that they never felt pain on injecting with PenMate" than with NovoPenB3 (Figure4).

Fear of injections may be one of the barriers to initiating insulin therapy in type 2 patients. Several studies have cited fear of needles and pain of injection as a source of negative attitudes to insulin therapy among type 2 diabetes patientscy. However, patients are generally able to overcome these fears through instruction and becoming accus- tomed to the routine of administering the injections9. Using an automatic injection device might speedup this process.

As blinding was impossible because of the

obvious differences between the devices, the VAS scores may have been influenced by the patients' desire for one device to be less painful. However, by sealing each VAS score in an envelope immediately after each measurement, past scores could not influence future ratings.

Safety Metabolic control was equally good with NovoPen@3 PenMatem and NovoPen@3 alone. This is hardly surprising as patients continued on their previous insulin regimens during the study and their HbA,, values had to be 9% or less for inclusion in the study. Local reactions, hypoglycaemic episodes and adverse events were similar with both devices.

Ease of use Nearly all patients found both devices easy to use. As all the patients in the study were used to a pen injector (having used one for at least six months), it is not surprising that a few patients found PenMaterM slightly harder to use with respect to changing cartridges and needles than NovoPen@3 (though the two devices were considered equally easy for performing the injection). This may be due to the slightly larger size of PenMaterM. The patient group for which PenMateTM is in- tended - those just starting insulin therapy and those with a fear of needles - may well appreciate the fact that the needle is not visible during injection rather than be con- cerned with the size of the device. Over 80% of the patients in this study said they would recommend PenMate? to a person who is uncomfortable with needles. The fact that the patients in this study were used to injecting insulin is a drawback for assessing the use- fulness of PenMaterM for patients who are uncomfortable with needles.

Most patients reported being uncom- fortable about using needles when they first started insulin therapy - 45.8% were very

much bothered by the needles at the start and 37.5% were somewhat bothered. While self- injection became a habit fairly rapidly for most, a few took years to get used to in- jecting. Nonetheless, despite all patients being used to self-injection at the time of the study, 27.3% said they would prefer to use PenMateTM in future and half of the patients thought it was an advantage not having to insert the needle themselves.

Conclusions This trial assessed pain perception, meta- bolic control and safety with NovoPena3 PenMatem compared with NovoPenW3 alone, and the general acceptability of the two devices. Short- and long-term metabolic control, hypoglycaemic events, local re- actions and adverse events were the same with both devices. The one difference was that injection pain was significantly less with PenMate". Thus, NovoPen@3 PenMaterM may offer important benefits to patients re- quiring insulin treatment who are uncom- fortable about using needles, with no risk in relation to metabolic control.

References I . Hamilton JG. Needle phobia: a neglected diag-

nosis.JFam Pract 1995;41: 169 2. b a s R, Ludvigsson J. Experience of pain from

insulin injections and needle-phobia in young patients with IDDM. Practical Diabetes Int 1997; 14: 95-9 3. Steel J, Taylor R, Lloyd G. Behaviour therapy for

phobiaof venepuncture. DiabetMed 1988; 3: 481 4. Jensen T, Moller L. Ortved-Andersen 0. Meta-

bolic control and patient acceptability of multiple insulin injections using NovoPen cartridge-packed insulin. Practical Diabetes I986 3: 302-06 5. Lee DM. How painful is intensive insulin therapy?

Z Gesamte Inn Med 1992; 41: 26-9 6. Bashoff ED, Beaser RS. Insulin therapy and the

reluctant patient: overcoming obstacles to success. Post- gradMed 1995; 97: 93-96

7. Weedon L, Curry M. Switching to insulin. Nursing Times 1992; 8 8 34-36 8. Miller F. When the client says 'no way' to insulin

therapy. Diabetes Educator 1995; 21: 187 9. Hunt LM, Valenzuela MA, Pugh JA. NIDDM

patients4ears and hopes about insulin therapy. The basis ofpatient reluctance. Diabetes Care 1997; 20: 292-98

PUBLISHERS' ANNOUNCEMENT

I 1

New Managing Editor of Practical Diabetes International

PMH Publications, the publishers of Practical Diabetes International, are pleased to announce the appointment of Kay Dempster as Managing Editor of this journal. Kay's scientific qualifications are in biochemistry and physiology (Southampton University) and she has had over ten years' experience of medical editing and writing, including periods with ADIS and PPS Europe. Her work has covered a broad range of clinical areas, including diabetes. She joined PMH Publications at the end of March.

Practical Diabetes International MarcWApril1999 Vol. 16 No. 2 41