6 Syringe Pens Ideal for Nurse Costumes

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Authors described a preference for the devices and suggested that they might contribute to improve adherence and QoL.

Sangave NA, Aungst TD, Patel DK. Smart connected insulin pens, caps, and attachments: a review of the future of diabetes technology. Diabetes Spectr. 2019;32:378–384. https://spectrum.diabetesjournals.org/content/32/4/378.abstract. Russell SJ, El-Khatib FH, Sinha M, et al. Outpatient glycemic control with a bionic pancreas in type 1 diabetes. N Engl J Med. 2014;371:313–325. https://www.ncbi.nlm.nih.gov/pubmed/24931572. El-Khatib FH, Balliro C, Hillard MA, et al. Home use of a bihormonal bionic pancreas versus insulin pump therapy in adults with type 1 diabetes: a multicentre randomised crossover trial. Lancet. 2017;389:369–380. https://www.ncbi.nlm.nih.gov/pubmed/28007348.Likewise, as we have previously mentioned, based on the expert consensus document by Tornero-Molina et al., and should being re-evaluated periodically, in situations where initial doses are necessary as in overweight patients, the switch from oral MTX to SC MTX is also recommended. 17 In support of this, evidence has demonstrated that SC MTX both as initial therapy in naive patients 20, 26 or subsequent therapy in non-responder patients improves treatment persistence, and clinical efficacy mainly due to its favorable bioavailability, 30 and optimizes the use of healthcare resources. 27 Notably, a recent subanalysis of the RA Excellence project in Spain showed that MTX escalation to full doses is not done with adequate speed and that the subcutaneous route is used in a small proportion of patients in clinical practice (only 12% of patients changed the route of administration). 31 Similarly, the study Symphony Health Solutions covering 274 million patients in the US showed that only 16% of patients were changed from oral to SC MTX. 18 That is, real-world evidence is highlighting the underuse of SC MTX after failure to oral administration, despite the recommendation that RA patients need to have tried and failed both oral and SC MTX before assuming a complete failure or intolerance to MTX and start biologics administration. This recommendation has been adopted considering the evidence that SC administration ensures higher plasma concentration and drug bioavailability, and thus greater clinical efficacy. 19, 20, 32 There is even evidence that the use of SC MTX after oral delays the onset of biological therapy. The MENTOR study, for example, provided evidence for the effectiveness and enhanced tolerability of SC MTX in prolonging disease control in patients who have failed oral MTX without necessarily the need to introduce alternative DMARD or biologic therapy. 33 Several studies have proposed that SC MTX has an important role to play in the long-term management of patients with RA from higher-cost treatment pathways to lower-cost treatment pathways. It can be also self-administered at home, providing an improvement in patient satisfaction. 34, 35 Taylor et al., provided an evidence-based discussion as to how to achieve the best outcomes with MTX in the management of RA highlighting that the parenteral administration of MTX has the advantages of maximising bioavailability, reducing gastrointestinal intolerance, and potentially enhancing compliance and adherence being highly cost-effective. 36 Based on the 2016 European League Against Rheumatism (EULAR) recommendations from 2016, MTX should be part of the first treatment strategy with csDMARDs, except in patients with contraindication and in case of non-response, change to another csDMARD as a strategy before adding a biological. 21 Shaw KF, Valdez CA. Development and implementation of a U-500 regular insulin program in a federally qualified health center. Clin Diabetes. 2017;35:162–167. https://pubmed.ncbi.nlm.nih.gov/28761218. Hyllested-Winge J, Sparre T, Pedersen LK. NovoPen Echo(®) insulin delivery device. Med Devices. 2016;9:11–18. https://www.ncbi.nlm.nih.gov/pubmed/26793007. Magennis C. The different types of insulin pumps available in 2019. https://www.dreambigtravelfarblog.com/blog/types-of-insulin-pumps (2019). Accssed 16 Feb 2020.

Assessments: device robustness and usability, patient perceptions (diaries, survey) and satisfaction, pharmacokinetics, safety and efficacy. Peyser T, Dassau E, Breton M, Skyler JS. The artificial pancreas: current status and future prospects in the management of diabetes. Ann N Y Acad Sci. 2014;1311:102–123. https://www.ncbi.nlm.nih.gov/pubmed/24725149. Taylor MJ, Gregory R, Tomlins P, Jacob D, Hubble J, Sahota TS. Closed-loop glycaemic control using an implantable artificial pancreas in diabetic domestic pig (Sus scrofa domesticus). Int J Pharm. 2016;500:371–378. https://www.ncbi.nlm.nih.gov/pubmed/26691655. Akturk HK, Snell-Bergeon JK, Rewers A, et al. Improved postprandial glucose with inhaled technosphere insulin compared with insulin aspart in patients with type 1 diabetes on multiple daily injections: the STAT study. Diabetes Technol Ther. 2018;20:639–47.Santos Cavaiola T, Edelman S. Inhaled insulin: a breath of fresh air? A review of inhaled insulin. Clin Ther. 2014;36:1275–89. RA is a good example of how the limitations related to the severity of disease and progression may affect medication adherence by complicating the procedure of self-autoinjection. A study in RA patients 47 showed a high level of patient acceptance of an autoinjector developed for facilitating the SC self-injection, which had been successfully tested in healthy volunteers 44 and patients with multiple sclerosis. 48 Notably, usability and compliance were successful in patients with severe hand disability. 47 The findings of this study add to the evidence supporting the use of autoinjectors to help improve treatment compliance among patients with chronic diseases. Hieronymus Laura GS. Insulin delivery devices. https://www.diabetesselfmanagement.com/diabetes-resources/tools-tech/insulin-delivery-devices/ (2019). Accssed 22 Nov 2019. Bolus calculator/bolus advisor mobile apps are platforms for insulin dose calculation available in smartphones. These can function independently or can be integrated into pumps to calculate the accurate insulin dose by incorporating expected carbohydrate intake, measured blood glucose values, and previous insulin doses [ 81]. Carbohydrate counting using bolus calculator apps has been found to improve glycemic control in MDI-treated diabetes patients [ 82]. Diabetes: M, mySugr (Roche), and PredictBGL are some of the most used bolus calculator apps. Bolus wizards are built-in automated bolus calculators specific to insulin pumps for insulin dose recommendations. The use of bolus wizards has been associated with better glycemic control and treatment satisfaction [ 83]. The 2016 Endocrine Society Clinical Practice Guidelines have strongly encouraged patients to use suitably adjusted built-in bolus calculators in CSII to enhance glycemic control [ 52]. Artificial Pancreas