The prescription of insulin pen devices versus syringes for older people with diabetes

Background — Insulin pen devices are easier to use and lead to better treatment adherence than syringes. This study sought to determine factors associated with the decision to prescribe insulin pen devices rather than syringes for older patients initiating insulin therapy.

Methods — A population-based study examined all Ontario, Canada residents ≥66 years old who received a first prescription for insulin between 1998 and 2006 (n = 47,810). Associations between demographic/clinical factors and the use of pen devices for insulin delivery were determined.

Results — Seventy-two percent of patients began insulin therapy using pen devices for insulin delivery, increasing from 46% in 1998 to 86% in 2006. Insulin initiation by a specialist was positively associated with the use of pen devices (odds ratio [OR] 2.24, 95% confidence interval [CI] 2.08–2.40), whereas long-term care residence (OR 0.51, 95% CI 0.49–0.54) and initiation during hospitalization (OR 0.74, 95% CI 0.71–0.78) were negatively associated.

Conclusions — Insulin pen devices were used by most patients starting insulin, but a substantial proportion of patients continued to be prescribed syringes for insulin delivery. The use of pen devices was positively associated with specialist care and negatively associated with insulin initiation during hospitalization. Increasing physicians' awareness of the benefits of pen devices to facilitate patient self-management could further increase their use and improve diabetes care.