Comparison of Outcomes and Costs between Pen Device and Syringe Usage for Premixed 70/30 Insulin in Diabetic Type 2 Patients

Abstract

Background: Because premixed 70/30 insulin is a fixed dose medication, dosing adjustments are limited. Penfill and insulin syringe are the insulin devices available at Warinchamrab Hospital. These devices are used by different techniques, which may result in a variation of blood sugar control outcomes.

Objectives: To compare the percentage of blood sugar control that achieve goal and the costs associated with insulin administration between the penfill users and the syringe users of premixed 70/30 insulin in type 2 diabetic patients.

Method: A retrospective study of data taken from electronic medical records of type 2 diabetic patients who have been treated as out-patients with penfill or syringe of premixed 70/30 insulin. The number of enrolled patients were 508 in the group of penfill users and 743 in the group of syringe users. Both groups were followed for 36 months from January 1, 2010 to December 31, 2021. Compare the percentages of hemoglobin A1c (HbA1c) and fasting blood sugar (FBS) that achieved the treatment goal of the penfill group and the syringe users group. Factors associated blood sugar control, and average costs per visit of medical and non-medical supplies were also studied.

Results: Target achievement rates in patients using penfill and syringe insulin were 67.3% and 42.8% (p-value < 0.001) for HbA1c, and 52.6% and 49.9% (p-value = 0.008) for FBS, respectively. The penfill group increased odds of the achieved goal for HbA1c 2.39 times compared with the syringe group (aOR=2.39, 95%CI 1.85-3.08, p-value < 0.001). Whereas the odds of achieving the goal for FBS was not different. Patients with diet control problem and those who received oral glycemic drug had decreased odds of the achieved HbA1c and FBS targets when compared to patients who had no diet control problem and did not receive an oral glycemic drug, respectively. The average costs of medical and non-medical supplies per visit for the penfill and the syringe users groups were 186.0 and 241.8 baht, respectively.

Conclusion: Type 2 diabetic patients who received premixed 70/30 insulin in the penfill group had higher HbA1c target achievement rate than the syringe users group. Cost of medication and devices per visit were lower in the penfill group compared to the syringe users group.