Pen Devices for Insulin Self-Administration Compared With Needle and Vial: Systematic Review of the Literature and Meta-Analysis
Open accessAbstract
Objectives: Pen devices offer advantages compared with vial and syringe (VaS). The purpose of this article was to evaluate efficacy of pen devices compared to VaS. Methods: A systematic review of literature was performed in 8 different databases. References were independently screened and selected. Primary observational or experimental studies comparing pen devices with VaS for insulin administrations were included. Studies on specific populations were excluded. Risk of bias was evaluated using appropriate tools. Data on glycosylated hemoglobin (HbA1c), hypoglycemia, adherence, persistence, patient preference, and quality of life (QOL) were collected. Meta-analysis was performed when appropriate. Heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses of the available data was done. Results: In all, 10 348 articles were screened. A total of 17 studies were finally selected: 7 experimental and 10 analytical. The populations of the included articles were mainly composed of adults with type 2 diabetes mellitus. Important risk of bias was found in all of the articles, particularly experimental studies. Meta-analyses were performed for HbA1c, hypoglycemia, adherence and persistence. Pen device showed better results in mean HbA1c change, patients with hypoglycemia, adherence and persistence compared to VaS. No difference was observed in number of patients achieving <7% HbA1c. Preference studies showed a tendency favoring pen devices, however nonvalidated tools were used. One QoL study showed improvements in some subscales of SF-36. Conclusions: There is evidence that pen devices offer benefits in clinical and, less clearly, patient-reported outcomes compared to VaS for insulin administration. However, these results should be taken with caution.
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Even when clinical characteristics suggest use of a particular medication based on clinical trial evidence, preferences regarding route of administration, injection devices, side effects, or cost may prevent use by some individuals.
“Even when clinical characteristics suggest the use of a particular medication based on the available evidence from clinical trials, preferences regarding route of administration, injection devices, side effects, or cost may prevent use by some individuals (65).”
From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [65]
The Preference and Discussion sections report that patients favored insulin pens over vials and syringes, and that injection pain can be a barrier to adherence. The paper does not establish that preferences about route of administration, side effects, or cost prevent people from using a medication indicated by clinical-trial evidence; its evidence concerns insulin delivery devices. (LLM, conf=0.84)
Experimental — accuracy not yet measuredInjecting insulin with a syringe or pen is the insulin delivery method used by most people with diabetes.
“Injecting insulin with a syringe or pen (136-147) is the insulin delivery method used by most people with diabetes (142,148), although inhaled insulin is also available.”
From 7. Diabetes Technology: Standards of Care in Diabetes—2025 (2025) · cites this paper as [142]
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Nhi, V. N. Y., Son, P. L., Dung, N. T., & Thuy, N. T. T. (2025) · TẠP CHÍ KHOA HỌC TRƯỜNG ĐẠI HỌC QUỐC TẾ HỒNG BÀNG · doi:10.59294/hiujs20250116
Saeed, A., Hussain, I., Gillani, A. H., Ullah, F., Ali, M., Khan, M. S., Maqbool, I., Khan, A. N., & Fang, Y. (2026) · BMC Health Services Research · doi:10.1186/s12913-025-13783-6
A Stroke Mimic Driven by Fear: Nonketotic Hyperglycemic Hemichorea in a Patient With Needle Phobia
Haroun, M., Khanal, S., Kakabadze, S. A., Abbas, H., & Udarbe, S. (2026) · Cureus · doi:10.7759/cureus.108735
Sargis, R. M., Reutrakul, S., Trasande, L., & Nadal, Á. (2026) · Current Diabetes Reports · doi:10.1007/s11892-026-01635-4
- Authors
- Lasalvia, P., Barahona-Correa, J. E., Romero-Alvernia, D. M., Gil-Tamayo, S., Castañeda-Cardona, C., Bayona, J. G., Triana, J. J., Laserna, A. F., Mejía-Torres, M., Restrepo-Jimenez, P., Jimenez-Zapata, J., & Rosselli, D.
- Affiliations
- Pontificia Universidad Javeriana (CO)
- Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
- Corresponding author
- Rosselli, Diego
- ORCID
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2016-02-25
- Volume
- 10
- Issue
- 4
- Pages
- 959-966
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC4928229
- OpenAlex
- W2292128997
- Cited by
- 63
- References
- 33
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 2 · 2023: 9 · 2022: 8 · 2021: 10 · 2020: 8 · 2019: 7 · 2018: 6 · 2017: 6
- FWCI
- 0.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Diabetes Science and Technology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- insulin pen devices, insulin self-administration, type 2 diabetes, glycemic control, HbA1c, hypoglycemia, medication adherence, patient preferences, quality of life, insulin delivery devices
- MeSH terms
- Diabetes Mellitus, Disposable Equipment, Humans, Hypoglycemic Agents, Insulin, Needles, Self Administration, Syringes
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