Kojic, N., Goyal, P., Lou, C. H., &

Annotated Bibliography-Needle-Free Diabetic Care

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Kojic, N., Goyal, P., Lou, C. H., & Corwin, M. J. (2017). An innovative needle-free injection system: comparison to 1 ml standard subcutaneous injection. AAPS PharmSciTech, 18(8), 2965-2970.

Published in May 2017, the article was authored by Nikola Kojic, Pragun Goyal, Cheryl Hamer Lou, and Michael J. Corwin. Nikola Kojic is a co-founder and CEO of Oryon Cell Therapies Inc., a startup in the field of regenerative medicine while Pragun Goyal is an inventor and Senior Mechanical Engineer at YRobot Inc. Currently, Cheryl Hamer works as a teacher at Glendale Unified in California. Dr. Michael J Corwin of Slone Epidemiology Center-Boston has interests in the physiology and epidemiology of sudden infant death syndrome. In this context, the article describes an assessment comparing two-needle systems; needle-free and the traditional injection system. The article demonstrates the role of needle-free care in improving compliance, satisfaction, and reducing anxiety among patients in need of frequent injections. Particularly, the text compares the perception of pain between portal instruments’ innovative needle-free injection and the 27G needle system. The intended audience for the article was patients in need of frequent injections, doctors as well as members of the public. The authors employed a unique method to arrive at their conclusions. They injected 40 healthy volunteers with two injections using the portal injection system and two using the 27G needle. They then used a visual analog scale to measure the perception of pain and assessed injection sites at 2 minutes and 30 minutes after injection. Kojic et al. concluded that a 1.0 mL saline injection can be administered using less pain than using a 27G needle. This is because 60% of the participants preferred portal injections as they are needleless. The main argument is that needleless injections are more advantageous than traditional needle systems because they are pain-free which makes compliance easy.

Ji, L., Gao, L., Chen, L., Wang, Y., Ma, Z., Ran, X., & Shan, Z. (2020). Insulin delivery with a needle-free insulin injector versus a conventional insulin pen in Chinese patients with type 2 diabetes mellitus: A 16-week, multicenter, randomized clinical trial (the FREE study). EClinicalMedicine, 23, 100368.

The article concerns a 16-week randomized clinical trial comparing insulin delivery between the convectional pen and needleless insulin injector among Chinese patients suffering from type 2 diabetes mellitus. The trial measured the compliance, patient satisfaction, tolerability, and glucose-lowering effect of insulin treatment using a needle-injector and compared it with a traditional convectional insulin pen. Ji et al enrolled 427 type 2 diabetes patients in a randomized study and randomly assigned 1:1 for a 16-week treatment. They found that patients that received insulin using the needle-free injection recorded higher treatment satisfaction scores compared to their counterparts that received insulin with the pen. Ji et. al. concluded that needle-free injector insulin therapy had enhanced patient satisfaction and a glycemic lowering effect that is non-inferior. Further, they concluded that the needle-free injectors have an enhanced safety profile. This text is useful as it provided valuable insight that can be used to enhance diabetic care. It points to increased compliance of medication uptake in the treatment of diabetes as well as an increased diagnosis because of the elimination of needles in administration of insulin.

Xing, Y., Xie, X., Xu, J., Liu, J., He, Q., Yang, W., … & Ji, Q. (2019). Efficacy and safety of a needle-free injector in Chinese patients with type 2 diabetes mellitus treated with basal insulin: a multicentre, prospective, randomized, crossover study. Expert opinion on drug delivery, 16(9), 995-1002.

This research focused on evaluating the safety and efficacy of needleless insulin injectors in Chinese patients presenting with type 2 diabetes. All listed authors played a part in the production of the text with everyone contributing to the discussion and reviewing the manuscript for critical content. As regards the method, the authors enrolled 62 type 2 diabetes patients in a crossover and randomized study where they either received insulin via glargine pen or needle-free injector for 7-14 days. The use of needleless insulin injectors was linked with less pain and less phobia of injection than the use of glargine pens. Xing et al. concluded that using needleless injectors significantly reduced the insulin dose needed to attain glycemic control as well as fear of injections and reactions needed to improve patient compliance. The text targeted diabetes patients and medical professionals in this field. This text is relevant as it can be used to develop more needleless gadgets that are safe in administering insulin hence saving the lives of people.

Yale, J. F., Dulude, H., Egeth, M., Piché, C. A., Lafontaine, M., Carballo, D., … & Guzman, C. B. (2017). Faster use and fewer failures with needle-free nasal glucagon versus injectable glucagon in severe hypoglycemia rescue: a simulation study. Diabetes technology & therapeutics, 19(7), 423-432.

Published in July 2017, the article compares the injectable glucagon and needle-free nasal glucagon among caregivers for ease of use in the management of severe hypoglycemia episodes. This is owing to the fact that diabetic people always need the help of other people during the treatment. The study involved 16 caregivers and 15 non-instructed acquaintances that administered injectable glucagons to manikins simulating during hypoglycemia episodes in unconscious people. Yale et. al concluded that it is easier for nonmedically trained people to inject nasal glucagon. This is because 90% of the participants managed to inject full nasal glucagon doses while 0% and 13% of acquaintances and caregivers only delivered full injectable glucagon doses. The text is reliable because the research was undertaken recently, in 2017, making the information up-to-date. Additionally, the fact that the article was published in the Diabetes Technology & Therapeutics Journal, a renowned journal, makes its content reliable. The text is useful as it points to the advantages of needle-free diabetic care; fewer failures and faster use, information that can be used to advance diabetes treatment.

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