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A Review of 20 Years’ Experience with the Novopen® Family of Insulin Injection Devices

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Abstract

NovoPen®, the first insulin pen injector, was introduced in 1985. This article reviews the published evidence over two decades of use of the NovoPen® family of injection devices in diabetes management. A search for NovoPen® publications from 1985 onwards was conducted in the following databases: MEDLINE/ PubMed, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstract Reviews and Effects, and Cochrane Controlled Trials Register. Publications were examined and underwent a selection process to identify studies of NovoPen® devices (NovoPen® [1], NovoPen® 2, NovoPen® 1.5 and NovoPen® 3) in the diabetes/insulin therapy area that contained evidence of the effects of NovoPen® in a variety of categories. Of the studies identified, most showed that insulin regimens using the NovoPen® family of devices are at least as effective (and in some cases superior) in maintaining glycaemic control and are as safe (in terms of hypoglycaemia) as conventional insulin regimens employing syringes. The published evidence identified also showed that insulin administration via NovoPen® devices was for most patients easier, more convenient and quicker than with conventional syringes and that most patients preferred the various NovoPen® devices over syringes. There was also some evidence that the use of discreet devices, like those of the NovoPen® family, facilitates adherence to intensive insulin therapy regimens, helps to improve lifestyle flexibility and reduces injection pain compared with conventional syringe-based regimens. Together these benefits of NovoPen® devices are considered likely to improve both patients’ quality of life and compliance with therapy.

In conclusion, a large body of published evidence accumulated over the past two decades testifies to the patient-related benefits of the NovoPen® family of insulin injection devices in the treatment of diabetes.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86

    Article  Google Scholar 

  2. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998; 352: 837–53

    Article  Google Scholar 

  3. Saurbrey N, Arnold-Larsen S, Moller-Jensen B, et al. Comparison of continuous subcutaneous insulin infusion with multiple insulin injections using the NovoPen. Diabet Med 1988; 5: 150–3

    Article  PubMed  CAS  Google Scholar 

  4. Saurbrey N, Berger A, Kuhl C. The NovoPen: a practical tool for simplifying multiple injection insulin therapy. Acta Paediatr Scand Suppl 1985; 320: 64–5

    Article  PubMed  CAS  Google Scholar 

  5. Engstrom LHK. Insulin pen for administration of isophane insulin. Practical Diabetes Int 1990; 7: 162–4

    Article  Google Scholar 

  6. Berger AS, Saurbrey N, Kuhl C, et al. Clinical experience with a new device that will simplify insulin injections. Diabetes Care 1985; 8(1): 73–6

    Article  PubMed  CAS  Google Scholar 

  7. Gnanalingham MG, Newland P, Smith CP. Accuracy and reproducibility of low dose insulin administration using pen-injectors and syringes. Arch Dis Child 1998; 79: 59–62

    Article  PubMed  CAS  Google Scholar 

  8. Gnanalingham MG, Newland P, Smith CP. An evaluation of NovoPen, BD-Pen, and syringe devices at small doses of insulin [abstract no. P118]. British Diabetic Association’s Medical and Scientific Section Spring Meeting; 1998 Mar 25–27; Heriot Watt University, Edinburgh; 1998, S49

  9. Keith K, Nicholson D, Rogers D. Accuracy and precision of low-dose insulin administration using syringes, pen injectors, and a pump. Clin Pediatr (Phila) 2004; 43(1): 69–74

    Article  Google Scholar 

  10. Murray DP, Keenan P, Gayer E, et al. An evaluation of a multiple-injection regimen, using the Novopen, in diabetes mellitus [abstract]. Ir J Med sci 1988; 157: 372

    Google Scholar 

  11. Murray DP, Keenan P, Gayer E, et al. A randomized trial of the efficacy and acceptability of a pen injector. Diabet Med 1988; 5: 750–4

    Article  PubMed  CAS  Google Scholar 

  12. Arslanoglu I, Saka N, Bundak R, et al. A comparison of the use of premixed insulins in pen-injectors with conventional patient-mixed insulin treatment in children and adolescents with IDDM. Is there a decreased risk of night hypoglycemia? J Pediatr Endocrinol Metab 2000; 13: 313–8

    Article  PubMed  CAS  Google Scholar 

  13. Bohannon NJ. Insulin delivery using pen devices: simple-to-use tools may help young and old alike. Postgrad Med 1999; 106: 57–8, 61-4, 68

    Article  PubMed  CAS  Google Scholar 

  14. Gall MA, Mathiesen ER, Skott P, et al. Effect of multiple insulin injections with a pen injector on metabolic control and general well-being in insulin-dependent diabetes mellitus. Diabetes Res 1989; 11: 97–101

    PubMed  CAS  Google Scholar 

  15. Small M, MacRury S, Boal A, et al. Comparison of conventional twice daily subcutaneous insulin administration and a multiple injection regimen (using the NovoPen) in insulin-dependent diabetes mellitus. Diabetes Res 1988; 8: 85–9

    PubMed  CAS  Google Scholar 

  16. Tallroth G, Karlson B, Nilsson A, et al. The influence of different insulin regimens on quality of life and metabolic control in insulin-dependent diabetics. Diabetes Res Clin Pract 1989; 6: 37–43

    Article  PubMed  CAS  Google Scholar 

  17. Tubiana-Rufi N, Levy-Marchal C, Mugnier E, et al. Long term feasibility of multiple daily injections with insulin pens in children and adolescents with diabetes. Eur J Pediatr 1989; 149: 80–3

    Article  PubMed  CAS  Google Scholar 

  18. Dahl-Jorgensen K, Hanssen KF, Mosand R, et al. The “insulin pen”: comparison with multiple injection treatment with syringe. Practical Diabetes Int 1986; 3: 90–1

    Article  Google Scholar 

  19. Henderson MJ, Tindall H. Evaluation of consumer satisfaction and quality of life in patients changing to Novopen II. Practical Diabetes Int 1990; 7: 206–8

    Article  Google Scholar 

  20. Walters DP, Smith PA, Marteau TM, et al. Experience with NovoPen, an injection device using cartridged insulin, for diabetic patients. Diabet Med 1985; 2: 496–7

    Article  PubMed  CAS  Google Scholar 

  21. Masson EA, McAughey D, Davies D, et al. The use of multiple insulin injection therapy using ‘NovoPen’ in a routine outpatient setting. Diabetes Res Clin Pract 1989; 7: 57–60

    Article  PubMed  CAS  Google Scholar 

  22. Stewart KM, Wilson MF, Rider JM. Insulin delivery devices. J Pharm Pract 2004; 17: 20–8

    Article  Google Scholar 

  23. Graff MR, McClanahan MA. Assessment by patients with diabetes mellitus of two insulin pen delivery sytems versus a vial and syringe. Clin Ther 1998; 20: 486–96

    Article  PubMed  CAS  Google Scholar 

  24. Kadiri A, Chraibi A, Marouan F, et al. Comparison of NovoPen 3 and syringes/vials in the acceptance of insulin therapy in NIDDM patients with secondary failure to oral hypoglycaemic agents. Diabetes Res Clin Pract 1998; 41: 15–23

    Article  PubMed  CAS  Google Scholar 

  25. Houtzagers CM, Berntzen PA, van der Stap H, et al. Efficacy and acceptance of two intensified conventional insulin therapy regimens: a long-term cross-over comparison. Diabet Med 1989; 6: 416–21

    Article  PubMed  CAS  Google Scholar 

  26. Houtzagers CM, Visser AP, Berntzen PA, et al. Multiple daily insulin injections improve self-confidence. Diabet Med 1989; 6: 512–9

    Article  PubMed  CAS  Google Scholar 

  27. Kolendorf K, Beck-Nielsen H, Oxenboll B. Clinical experience with NovoPen® II and insulin Protaphane® HM Penfill®. Postgrad Med J 1988; 64Suppl. 3: 14–6

    PubMed  Google Scholar 

  28. Valk NK, Cerny G, Sieber J, et al. Efficacy and safety performance of the Innovo insulin doser. Diabetes Technol Ther 2004; 6: 53–8

    Article  PubMed  CAS  Google Scholar 

  29. Su CC, Chen HS, Lin HD. Glycemie control with different premixed insulin in Taiwanese people with type two diabetes mellitus. J Chin Med Assoc 2003; 66: 155–9

    PubMed  Google Scholar 

  30. Katoulis EC, Makris GS, Ioannou JC, et al. Longterm (2 years) comparison of basal-bolus Novopen and conventional regime in insulin dependent diabetics [abstract]. Diabetes 1991; 40: 456

    Google Scholar 

  31. Spijker AJ, Hoekstra JBL, Erkelens DW. The insulin pen: a new device for multiple insulin injections. Transplant Proc 1986; 18: 1689–90

    Google Scholar 

  32. Seshaiah V, Rais N, John L, et al. NovoPen® 1.5 in Indian women with gestational diabetes mellitus [abstract no. 1302]. 16th International Diabetes Federation Congress; 1997 July 20-25; Helsinki. 1997: A331

  33. Bak JF, Nielsen OH, Pedersen O, et al. Multiple insulin injections using a pen injector versus insulin pump treatment in young diabetic patients. Diabetes Res 1987; 6: 155–8

    PubMed  CAS  Google Scholar 

  34. Salardi S, Cacciari E, Zucchini S, et al. Modifications of metabolic control in type 1 diabetic children and adolescents: experience over the last 20 years. J Pediatr Endocrinol Metab 1997; 10: 569–78

    Article  PubMed  CAS  Google Scholar 

  35. Chang G, Chia J, Rahayu S, et al. Evaluating the use of the Novopen 3 insulin delivery sytem in Singaporean Diabetes subjects [abstract no. P158]. 17th International Diabetes Federation Congress; 2000 Nov 5–10; Mexico City. 2000: S20

  36. Jefferson IG, Marteau TM, Smith MA, et al. A multiple injection regimen using an insulin injection pen and pre-filled cartridged soluble human insulin in adolescents with diabetes. Diabet Med 1985; 2: 493–5

    Article  PubMed  CAS  Google Scholar 

  37. Jensen T, Moller L, Ortved Andersen O. Metabolic control and patient acceptability of multiple insulin injections using NovoPen cartridge-packed insulin. Practical Diabetes Int 1986; 3: 302–6

    Article  Google Scholar 

  38. Jenkins HR, Hinton JL, Williams H, et al. A study of metabolic control and patient acceptability in adolescent diabetics using the NovoPen. Practical Diabetes Int 1989; 6: 14–5

    Article  Google Scholar 

  39. Distiller LA, Robertson LI, Moore R, et al. A bolus/basal multiple injection regimen in type I diabetes: a multicentre trial using a new ‘fountain-pen’ device for short-acting human insulin as well as long-acting human insulin. S Afr Med J 1987; 71: 749–52

    PubMed  CAS  Google Scholar 

  40. Dinneen SF, Cronin CC, O’Sullivan DJ. Long term efficacy of a pen injector. Ir J Med sci 1991; 160: 286–7

    Article  PubMed  CAS  Google Scholar 

  41. Houtzagers CM, van der Velde EA. Multiple daily insulin injections: a multicentre study on acceptability and efficacy. Neth J Med 1988; 33: 16–25

    PubMed  CAS  Google Scholar 

  42. Dunn PJ, Jury DR. Multiple dose insulin regimen using the NovoPen: initial experience and approximate dose requirements. N Z Med J 1986; 99: 226–30

    PubMed  CAS  Google Scholar 

  43. Hyer SL, Froyd HE, Kohner EM. Effect of the NovoPen on glycemic control and patient independence in diabetics with visual impairment. Practical Diabetes Int 1988; 5: 197–9

    Article  Google Scholar 

  44. Fövényi J, Szoverffy G, Thaisz E, et al. Experiences with functional insulin substitution: a follow-up study on control and patient compliance. Acta Med Hung 1992; 49: 53–64

    PubMed  Google Scholar 

  45. Mora Mora PF, Wilk T, Shaw KM. Use of NovoPen 3® in a homeless population: efficacy, preference and biosafety [abstract no. 917P]. 60th Scientific Sessions of the American Diabetes Association; 2000 Jun 9–13; San Antonio (TX). 2000: A221

  46. Wilk T, Mora PF, Chaney S, et al. Use of an insulin pen by homeless patients with diabetes mellitus. J Am Acad Nurse Pract 2002; 14: 372–9

    Article  PubMed  Google Scholar 

  47. Romanian Young Diabetics Study Team (RYDST). Mixtard 30 HM Penfill insulin treatment in selected young insulin-dependent diabetes mellitus patients. Romanian Young Diabetics Study Team (RYDST). Rom J Intern Med 1997; 35: 99–113

    Google Scholar 

  48. Hardy KJ, Jones KE, Gill GV, et al. NovoPen worsens blood glucose control in female diabetics [abstract]. Diabet Med 1990; 7Suppl 1: 23

    Google Scholar 

  49. Sommerfeldt E, Oygard R, Sander J, et al. Novopen: a useful aid also for blind diabetic patients. Diabetes Care 1989; 12(4): 306–7

    PubMed  CAS  Google Scholar 

  50. Lunt H, Smith RB. Multiple dose insulin regimen using the NovoPen. N Z Med J 1986; 99(802): 379

    PubMed  CAS  Google Scholar 

  51. Santiago OM, Khutoryansky NM, Bilbo CM, et al. Accuracy and precision of the NovoPen® 3 insulin delivery device after mechanical and temperature stresses. Endocr Pract 2002; 8(5): 351–5

    PubMed  Google Scholar 

  52. Gordon D, Wilson M, Paterson KR, et al. An assessment of the accuracy of NovoPen 1 delivery after prolonged use. Diabet Med 1990; 7(4): 364–6

    Article  PubMed  CAS  Google Scholar 

  53. Lteife AN, Schwenk WF. Accuracy of pen injectors versus insulin syringes in children with type 1 diabetes. Diabetes Care 1999; 22: 137–40

    Article  Google Scholar 

  54. Newman KD, Weaver MT. Insulin measurement and preparation among diabetic patients at a county hospital. Nurse Pract 1994; 19(3): 44–5, 48

    Article  PubMed  CAS  Google Scholar 

  55. Costello C, Calabrese G, Fedele D, et al. Use of premixed insulin among the elderly: reduction of errors in patient preparation of mixtures. Diabetes Care 1992; 15(11): 1628–30

    Article  Google Scholar 

  56. Diglas J, Feinbock C, Winkler F, et al. Reduced pain perception with Pen Mate™, an automatic needle insertion device for use with an insulin pen. Practical Diabetes Int 1999; 16: 39–41

    Article  Google Scholar 

  57. Hörnquist JO, Wikby A, Andersson P-O, et al. Insulin-pen treatment, quality of life and metabolic control: retrospective intra-group evaluations. Diabetes Res Clin Pract 1990; 10: 221–30

    Article  PubMed  Google Scholar 

  58. Hunt LM, Valenzuela MA, Pugh JA. NIDDM patients’ fears and hopes about insulin therapy: the basis of patient reluctance. Diabetes Care 1997; 20(3): 292–8

    Article  PubMed  CAS  Google Scholar 

  59. Liebermeister H, Sammler A. Problems of the elderly, insulin injecting diabetic patients in ambulatory care [in German]. Versicherungsmedizin 1990; 42(2): 59–64

    PubMed  CAS  Google Scholar 

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Acknowledgements

This study was supported by Novo Nordisk (Bagsvaerd, Denmark), where all the authors are employed.

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Correspondence to Klaus H. Jensen.

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Rex, J., Jensen, K.H. & Lawton, S.A. A Review of 20 Years’ Experience with the Novopen® Family of Insulin Injection Devices. Clin. Drug Investig. 26, 367–401 (2006). https://doi.org/10.2165/00044011-200626070-00001

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