Counseling Patients About the Importance of Appropriate Pen Needle Administration

Pen needles (PNs) are an imperative medical device required for adequate management of diabetes. Compared with the original means of a vial and syringe, PNs improve insulin administration by increasing dose accuracy, dexterity, and comfort. PN use has also been associated with higher insulin adherence, leading to lower diabetes-related costs and subsequent health care resource use.

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However, PNs still tend to have higher unit costs, which could place a financial burden on patients and lead to the temptation to reuse needles. Improper PN administration, including reuse, can result in dull PN tips, leading to needle deformity or breakage. Subsequently, patients are at a much higher risk for contamination of the PN, leading to lipohypertrophy (fatty deposits) or pain at the injection site. To ensure that diabetes treatment is optimal, it is crucial for patients to use PNs appropriately.

A team of researchers from across the US retrospectively evaluated PN use patterns, with findings published in the May 2024 issue of the Journal of the American Pharmacists Association. They extracted data from claims from patients with diabetes covered by commercial insurance or Medicare Advantage (Table¹). The fill rate for PNs overall was lower than expected, indicating the potential for PN reuse, particularly in the commercially insured population, in which between 2% and 27% of patients are expected to use their PNs at least 5 times based on refill rates.

Out-of-pocket costs may contribute to the high incidence of expected PN reuse. Although this may be a nonmodifiable variable in patient care, pharmacists can help patients improve self-management by relaying education about how overall outcomes are more positively associated with proper PN administration. By improving the management of diabetes, alternative health care costs may be reduced, offsetting the monthly expenditures for materials.

Whether a patient is filling a prescription for PNs repeatedly or for the first time, pharmacists can provide thorough counseling to promote optimal administration and therefore outcomes.¹ First, selecting the appropriate needle gauge and size can promote comfort. Experts recommend using the smallest-sized needles (4-mm length, 32 gauge). For the average adult, using the smaller needle ensures reliable subcutaneous administration into tissues.

Pharmacists should also remind patients of the proper sites for subcutaneous administration, including the back of the upper arm, stomach, waist, buttocks, and the front or side of the thighs. Although there are various options, observing the patient and their body type can ensure an ideal recommendation. Most patients will feel most comfortable with the stomach or waist area if self-administering. In patients with high muscle tone, using the fleshier areas would be preferred. Patients should avoid any site that is injured, bruised, or otherwise impaired and should rotate sites continually to avoid irritation. Pharmacokinetics may be altered in areas of abnormal subcutaneous tissue, including the lesions that may develop when PNs are reused. Inadequate absorption can result in reduced glycemic control, further emphasizing the importance of adequate administration. The Figure highlights appropriate sites of subcutaneous administration.

CONCLUSION

Injectable medications continue to come down the pipeline for various indications apart from diabetes. Providers may prescribe such therapies for anticoagulation, weight loss, or as immunotherapy. Many of these agents are being manufactured as single-use pens that do not require the PNs separately, providing increased ease of use for patients. However, there are still injectable medications that may require an additional prescription for PNs. Pharmacists can familiarize themselves with these nuances by reviewing package inserts and using manufacturer websites and videos with administration instructions.

Pharmacists remain front-line health care professionals in their communities. Counseling patients and caregivers who fill prescriptions for injectable medications and emphasizing the importance of single use administration can optimize PN use. By teaching patients to manage their conditions well, pharmacists can have a profound impact on patient outcomes.

REFERENCE

Lupton L, Sun X, Javadi P, et al. Pen needle use patterns in an insured population with diabetes: U.S. retrospective claims analysis. J Am Pharm Assoc (2003). 2024;64(4):102124. doi:10.1016/j.japh.2024.102124