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Training Diabetes Patients on Self-Injection Is Essential

May 14, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Joe Reynolds, Research Manager, Noble

Training devices for autoinjectors can help ensure diabetes patients learn self-injection properly.

Ensuring that diabetes patients correctly administer their insulin or glucagon is a priority for prescribers and patients alike. Keeping tabs on the extent to which patients are (or are not) taking their medications as prescribed, however, is increasingly complicated due to technical innovations in drug delivery.

Diabetes Patient Insulin Self-InjectionWith the gradual evolution from traditional “dial-and-dose” injection pens for daily use, toward autoinjectors intended for weekly use, patients may enjoy greater convenience when self-injecting. Yet, amid all potential use cases, it remains vital that patients utilize their devices properly. Consequently, training can be key to ensuring positive outcomes.

Training and onboarding using traditional injection pens has typically occurred in healthcare providers’ (HCP) offices, with patients instructed to use the actual device on an injection pad prior to their first real injection to get a feel for the proper technique. More recently, patients prescribed autoinjectors increasingly have the option to use realistic training devices that replicate the appearance, sound, feel and forces of actual commercial autoinjectors. This is significant because these trainers can provide diabetes patients with an opportunity to train at home and gain familiarity with proper device use while also helping them combat natural memory decay that can occur between doses. This training also allows patients to report on their technique to HCPs and Certified Diabetes Educators (CDE) and receive feedback for improvement.

A recent longitudinal study found that patients with access to training materials outside an HCP office performed significantly better than those with traditional training and no training device for practice. The study enrolled healthy adults with no professional medical training and split them into three cohorts. Each cohort first attended an in-office session demonstrating the proper use of a mechanical autoinjector training device—much like a patient would receive initially upon being prescribed a self-injection.

Cohort A was sent home with only a medication IFU; Cohort B was sent home with a mechanical trainer and a training IFU; and Cohort C was sent home with a mechanical trainer, training IFU and an interactive training video. Participants used the support materials to prepare for or practice self-injecting on their own for 14 days. Upon returning for a follow-up session, they were asked to conduct a simulated injection using a real autoinjector and injection pad.

Research found that 100 percent of Cohorts B and C completed all critical steps for a successful self-injection, while only 44 percent did so from Cohort A. Findings were significant within Cohort C—those who took home an IFU, a training device and the video–as well; participants in Cohort C performed better than their counterparts, successfully completing all critical steps during their simulated injections.

Along with an increase in successful injections, participants who had a training device on hand at home showed significantly increased engagement in terms of how often they chose to prepare for self-injecting over the 14 days. Cohorts B and C were able to prepare for and practice at home more than those who had just been sent home with the IFU leaflet alone. Findings from the study showed in both Cohort B and C that 100 percent of participants practiced at least three times over the two weeks. In Cohort B, slightly more than half practiced five to nine times, and approximately one-third practiced 10 or more times.

Additional studies indicate that not all patients prescribed autoinjectors read the Instructions for Use (IFU) and other forms of print collateral commonly used for patient training and education. Subsequently, a large percentage of patients make errors when using autoinjectors, many of which could be mitigated through proper training and on-boarding using a trainer.

Practicing with trainers could also help alleviate the anxiety that can come with self-injection. According to one study, 64 percent of patients who self-inject reported that having a training device to practice with at home would help decrease their anxiety, and 89 percent reported it would be very important to have the most realistic training possible. Moreover, 89 percent of patients reported having a better understanding of a real injection as a result of practicing with a training device.

As the number of diabetes patients continues to rise, and the available drug delivery options proliferate, proper training will become an ever-greater priority. Trainers for autoinjectors and other devices may play a valuable role in this regard.

Practice Pearls:

  • The evolution of diabetes drug delivery toward autoinjectors highlights the need for patients to receive adequate training on device use.
  • Training devices have been developed that mimic the appearance, sound, feel and forces of actual commercial autoinjectors.
  • Studies suggest that using training devices significantly enhances the performance of patients who self-inject and help them learn proper self-injection technique.

Guest Author: Joe Reynolds, Research Manager, Noble

References:

Abraham R. “For Patients Who Self-Inject, Training Devices May Hold Multiple Benefits.” National Pain Report. Available at: http://nationalpainreport.com/op-ed-for-patients-who-self-inject-training-devices-may-hold-multiple-benefits-8838652.html

Butschli J. “Training Patients to Self-Inject Medications Key to Improved Adherence.” HealthcarePackaging.com. Available at: https://www.healthcarepackaging.com/article/training-patients-self-inject-medications-key-improved-adherence

Noble. “The Link Between Device Training and Patient Compliance.” Poster session. 2015. Presented at PDA Universe of Prefilled Syringes & Injection Devices Conference, Vienna, Austria.