Insulin Pen Instead of Syringe Saves Hospital Bills For Type 2s

Since Novo Nordisk recently released an improved FlexPen in the United States, we thought we’d remind you of one of their values.

Type 2s who start their insulin with pens end up requiring much less medical care.

| Mar 21, 2009

In a study funded by Novo Nordisk, researchers at Ohio State University have found that type 2s who move from oral meds to insulin would be wise to start with an insulin pen rather than a syringe.

It's not because the pens cost less than syringes and vials; in fact, they cost more. Rather, it's because type 2s who start their insulin with pens end up requiring much less medical care.

The researchers compared 1,162 type 2 Medicaid patients who began insulin therapy with syringes to 168 who began insulin by using Novo Nordisk insulin pens. They found that only about half the people in either group took their insulin properly, a fact that they attributed to the poor overall care that low-income people receive from Medicaid.

After summing up the costs of each group's emergency room visits, hospitalizations, and outpatient visits for diabetes-related conditions, the average cost for pen users was $14,857 a year. For syringe users, however, it was a whopping $31,764.

In another study, the same researchers compared more than 1,100 patients who were already on insulin when the study began. Half switched to a pen, and half stayed on injections. In that study, annual healthcare costs of pen users were more than for syringe users: $11,476 versus $10,755.

The researchers explained this contradictory finding by noting that pens are more expensive initially. They also hypothesized that pen users probably took their insulin as often as they were supposed to and that syringe users probably didn't, resulting in higher insulin costs for the pen users.

Source: EurekAlert; Clinical Therapeutics, August 2007

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Categories: Diabetes, Diabetes, Insulin, Novo Nordisk, Pens, Syringes, Type 2 Issues

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Posted by Colleen Fuller on 23 March 2009

I'm disappointed that Diabetes Health is citing a study that is nearly 2 years old that not only was funded by Novo Nordisk, but whose key authors were on the company's payroll. The study, Health Care Costs and Medication Adherence Associated with Initiation of Insulin Pen Therapy in Medicaid-Enrolled Patients with Type 2 Diabetes: A Retrospective Database Analysis, was published in Clinical Therapeutics, Vol. 29 in mid-2007. The Medicaid database analysis was funded by Novo Nordisk. Two of the six authors are paid consultants with Novo Nordisk, one was working for Novo at the time of the study and another one was a Novo employee by the time the study was completed.

The study found that the costs to the patients using syringes were signficantly lower than for those using an insulin pen. The authors concluded that "Future research considering laboratory values such as HbAlc and different health care settings is needed to determine the long-term effects and potential benefits of insulin pen therapy and its impact on treatment adherence."

This is an important caveat that should have been included in your article, along with information about who funded the study and conflicts of interest among the majority of its authors. Shame on you.

Posted by Jerry1423 on 24 March 2009

I am a type 1 diabetic.
I have tried the pens and do not like them. I do not like that they are much bigger than a syringe, so therefor not as portable. I also do not like that the user can only inject whole units of insulin - I can easily measure 1/2 units of insulin with the syringes that I use.
I just see this article as a way for another company to make much more money from something that really is not necessary.

Posted by Anonymous on 24 March 2009

To Jerry1423:

You can dose insulin in 1/2 units in the NovoLog Junior Pen. It is a refillable metal pen. That's what I use just for that reason.

Posted by Anonymous on 24 March 2009

I have been using the Novolog flex pen since it arrived on the market and am also using the Lantus pen (At first I used the one that was a permanent pen with disposable vials which was too cumbersome to use. They now have the disposable ones.)

I have been a diabetic for 22 years with resulting kidney disease (transplant 5/29/06), stroke, etc. I find these pens to be more convenient to use, I can store them at work and at home, and even keep the humalog in my purse when traveling back and forth. I found the syringes to be inconvenient, had trouble measuring and seeing the dose and just too much trouble.

Now I take my dose(s) of insulin regularly (total of 5 injections a day) and my A1c in January was 6.6. Not bad for someone who was over 8 most of the time.

Posted by teenymite on 24 March 2009

I have tried to use the pen and I really dislike it. It seems to take more coordination than I have. Not to mention that if you need 25 units and there are only 10 left in the pen, you either waste 10 (which adds up) or end up with an extra poke.

Posted by Anonymous on 24 March 2009

I agree with the other comments. This is not a helpful article, and is misleading at best. The second study seems to indicate that there is little or no difference in cost of using pens versus syringes.

Posted by Anonymous on 24 March 2009

Pens are so much easier to carry and use. I can carry the pen in my purse, lunchbag or whereever I go and can use it with ease. I use a syringe and vial for my Lantus, taken at home. The pen insulin can be taken along easily and used discretely at a restaurant or anywhere I need to administer insulin. I will not switch from the pen, no matter who did the study.

Posted by ron humphrey on 24 March 2009

i have been a type 1 diabetic for 60 years and am 60 now. always used syringes + needles, i take 3 injections/day of novolog and 1 of lantus. my doctor introduced me to the pens about 6 months ago. after a break in period of a few days i would never go back to the old way again.

Posted by Ginny718 on 24 March 2009

I have diabetes type 2 for 22 years. I was switched to the Novalog Flex pen after my stroke and kidney transplant and the doctors also added the Lantus pen. I inject 5x times a day. Both pens are much better than using the syringes. I can just dial up the number needed and I have no trouble seeing the numbers. I keep pens in a refrigerator at work, at home, and the Novalog pen in my purse when I go out to eat, shop, etc.

With the Lantus pen, I take 90 units a day so I do sometimes inject twice when I am near the end. With the Novolog Flex pen, I have to vary the dosage so I don't really care is I have to lose a couple of units.

In my opinion, the pens are much better. My A1c in January was 6.6. Not bad for someone who was always over 8.

Posted by Anonymous on 24 March 2009

I loved the insulin pen when I was able to use it during a couple of years of a diabetes study through a major university hospital in Dallas a # of years ago. However, when the study ended, my insurance company through my employer refused to cover the insulin pen, needles and insulin...their excuse: "the higher cost". They would only cover syringes and vial insulin. Even though there are a few issues of inconvenience with the insulin pen, I'd much rather use that in public than having to drag out an insulin vial and syringe. Nothing is ever easy...particularly for a diabetic and the costs involved.

Posted by Anonymous on 24 March 2009

I have been type II for about 10 years. Always took oral. Finally maxed out. Always told Doc if I had to take a shot it would only be one time cause it would be 38 caliber. About 9 months ago I finally decided to try the pen. Silly me. It is usually painless, and infrequently just a little bit of a prick. Currently take 24 units once a day at bedtime, combined with my orals. Still not sure if I could do the regular needles, but this is no big deal. See, I'm a real chicken when it comes to needles, in my hand at least. Try the pens, its easy, painless, and a no brainer. Male aged 66.

Posted by Anonymous on 24 March 2009

As mom of a type 1--the pen was tried & my son really dislike it; he preferred to inject with syringe. It was easier to be certain that the correct amount of insulin was injected--any unexpected "high" with the pen just made him wonder if it was the pen not functioning correctly.

As an RN in hospital, I have to tell you that Novo Nordisk has benefitted hugely as hospitals have moved away from subcutaneous injection by needles (to avoid using glass bottles to withdraw insulin for muliple patients). Not only pens, but also an administration device that looks similar to a cooking timer to deliver the dose. Again, when the expected results are not achieved (decreased blood glucose)--it makes the staff really concerned that the medication hasn't been delivered from these devices. Sure you dial in your dose, but there's a lot to be said for actually "seeing" the medication leave a syringe.

There are other concerns I have about the pens and the cartridges--too much to go into here. I agree with the first post critical of this 2-year-old, pharmaceutical-sponsored study.

Posted by Anonymous on 24 March 2009

I have worked as a diabetes educator for about 20 years, and seen thousands of people with diabetes. Many people really like pens because they feel pens are convenient, discreet easy-to-use, and easy to set at the proper dosage. But other people, like those who posted above about not liking pens, prefer syringes.

I see this as one example of the many things in diabetes care that should be individualized. If a person prefers syringes, and can dose accurately with syringes, great! If another person prefer pens, and can dose properly with a pen, that's great too!

By the way, for the person who said you can only dose whole units with a pen -- on both the NovoPen Junior and the HumaPen Luxura HD, the dose is set in 1/2 units.

Posted by Anonymous on 25 March 2009

Pen vs syringe is a personal choice. The issue is many people with diabetes are not given that choice. As a CDE, I introduce both to patients, but it is the MD that writes the prescriptions. If a person with diabetes has not seen a CDE (which is a majority unfortunately) they get what they are prescribed and may not know there is a choice. You should always be given the option and make an informed decision.

Posted by dorisjdickson on 25 March 2009

I'm with Colleen. Shame on you guys. This "opinion" is far below your normal standard. I would never be allowed to write/publish such a biased "article" on Diabetes1. It might get blog worthiness but not a feature article. I'd get my butt kicked for such bias.

I don't care what type of diabetic we are discussing. Syringes and vials are far less expensive and since 1/2 unit syringes and dilutants are available, syringes are far more accurate IF the patient is taught properly.

There are no insulin pens in which I can use dilutant (as an insulin sensitive person) or use 1/2 units (must start at 1 1/2 units and not all products have 1/2 unit pens). Not everyone uses large doses.

Of course this study would show in favor of pens - NovoNordisk makes tons on these products and they make nothing on syringe sales. Shoot, I recommended at the Diabetes Expo they sell smaller vials so there would be less waste - now why would they do that? They have us by the you know whats - we have no choice but to buy insulin whatever the formulation, safety or cost.

I'm for cutting costs not increasing them. We ALL pay for other people's costs in our premiums and/or taxes. Why make it worse when there are less expensive safe options. Teaching is the variable not the tool.

Try again guys and please provide more timely, less biased information next time.


Doris J. Dickson

Posted by Anonymous on 3 October 2011

I am a type 2 diabetic for 16 years now and am also a stroke victim. I currently use the syringe vial insulin and have to have someone fill my syringes for me since I am also a stroke victim with use of only one hand. I would like to know if the pens could be used with just one hand or would both hands be needed? Any info regarding that would be appreciated.

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