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Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment

Authors Davida Kruger, LaRue S, Estepa P

Received 29 July 2014

Accepted for publication 17 October 2014

Published 16 January 2015 Volume 2015:8 Pages 49—56

DOI https://doi.org/10.2147/DMSO.S71923

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Ming-Hui Zou


Davida F Kruger,1 Susan LaRue,2,3 Phil Estepa3

1Henry Ford Health System, Detroit, MI, USA; 2Amylin Pharmaceuticals, San Diego, CA, USA; 3AstraZeneca, San Diego, CA, USA

Abstract: Injectable treatments, such as glucagon-like peptide-1 receptor agonists and insulin, are options for the pharmacologic treatment of type 2 diabetes. Numerous barriers lead to delay in initiating injectable treatment, which, in turn, may lead to inadequate glycemic control and increased risk of diabetes-related complications, underscoring the need to understand and address these barriers. Barriers to the initiation of injectable therapy, strategies to mitigate barriers, and information about needle attributes and their relation to needle pain are reviewed on the basis of published literature retrieval and our clinical experience. Barriers to the initiation of injectable therapy originate from both patients and practitioners. Anxiety about and fear of injection-associated pain has been estimated to affect approximately 30%–50% of patients before the initiation of diabetes education interventions. Advances in needle design have minimized the pain associated with injections, and recent data suggest that actual pain and bleeding associated with various needle gauges (21-gauge to 31-gauge) are mild. Other barriers include concerns about the ability to handle injectable therapy, concerns about treatment side effects, and impacts on quality of life. Practitioners can help to mitigate barriers to injectable treatment for type 2 diabetes by understanding patient perceptions, improving education, and setting realistic expectations about therapy. Strategies for minimizing injection-associated fear and anxiety include a combination of assessment, appropriate needle selection, patient education, behavioral interventions, and monitoring.

Keywords: type 2 diabetes, injection, needle, anxiety, fear


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