A Comparison of Insulin Injection Needles on Patients' Perceptions of Pain, Handling, and Acceptability: A Randomized, Open-Label, Crossover Study in Subjects with Diabetes

BACKGROUND: For some diabetes patients, subcutaneous injections are associated with pain, discomfort, and anxiety. We compared overall preferences of two needle types: NovoFine((R)) 32-gauge tip x 6 mm and NovoFine 30-gauge x 8 mm, when used with the FlexPen((R)) injection device (all from Novo Nordisk A/S [Copenhagen, Denmark] and Novo Nordisk Ltd. [Crawley, UK]). METHODS: In this randomized, open-label, two-period, crossover trial in 119 insulin-treated patients with type 1 (22%) or 2 diabetes, patients injected their usual insulin with one needle type followed by the alternative, each for 7-14 days. Needle preference and perceptions of pain, handling, and acceptance were assessed using a questionnaire after use of each needle. RESULTS: Overall, 58% preferred the NovoFine 32-gauge tip, 26% preferred NovoFine 30-gauge tip, while 16% had no preference (P < 0.001 between needles). Subjects injecting </=40 or >40 (I)U/day and two or fewer or more than two injections/day all preferred NovoFine 32-gauge tip over NovoFine 30-gauge tip (all P < 0.05). Little or no pain (<5 mm on a 100-mm Visual Analog Scale) was experienced by 57% of subjects when using NovoFine 32-gauge tip and by 40% when using NovoFine 30-gauge tip. More subjects found the injection button easier to press with NovoFine 30-gauge tip (P < 0.01). Responses for ease of insertion, needle sharpness, and performance favored the NovoFine 32-gauge tip; ease of pushing insulin out through the needle favored NovoFine 30-gauge tip. One person for each needle type reported bleeding/bruising at the injection site. CONCLUSIONS: NovoFine 32-gauge tip x 6 mm needles are a viable alternative to NovoFine 30-gauge tip x 8 mm needles for people administering daily insulin injections.