The critical role of pen needles and training in insulin delivery

Following the EU Directive 2010/32/EU, Prevention from sharps injuries in the hospital and healthcare sector, which came into force in 2010, legislation was rolled out relating to the use of safety sharps when administering insulin to patients with diabetes (European Agency for Health and Safety at Work, 2010). Safety devices use a mechanism with either a passive or active activation that covers the needle and helps reduce the risk of needlestick injuries (NSIs). However, the EU Directive did not state a preference for which type of safety pen needle to use in the clinical space. Thus, the choice is left to medical institutions.

Both active and passive devices are designed to help improve the patient experience and be intuitive to use. However, the two devices have some fundamental differences and benefits.

The key difference is that, along with an automated safety mechanism, passive devices typically cover the needle before and after the injection process, which protects against NSIs but can make it difficult to see the needle and requires the user to use a different injection technique from standard pen needles. Crucially, the passive mechanism requires consistent pressure on the skin to function properly and, if this pressure is lost, the safety feature activates. If this happens prematurely, the administration is interrupted, and medication can remain undelivered – often confirmed with visible pooling of the insulin on the patient's skin and undelivered medication remaining in the passive device.