Background: Gestational diabetes mellitus (GDM) is one of the most common pathologies in pregnancy. Unfortunately, both clinicians and patients are often reluctant to begin insulin therapy, a phenomenon that has been ...Background: Gestational diabetes mellitus (GDM) is one of the most common pathologies in pregnancy. Unfortunately, both clinicians and patients are often reluctant to begin insulin therapy, a phenomenon that has been known as psychological insulin resistance (PIR). Objectives: To assess the barriers of initiating insulin among GDM pregnant women. Patients and Methods: An observational cross-sectional study was conducted in the GDM clinic, Diabetes Center in Hera’a General Hospital, Makkah, Saudi Arabia in a period of 4 months. A self-administered validated questionnaire was adopted. It included socio-demographic data of women, perceived (personal, social, pharmacological, occupational and misconception) barriers towards insulin therapy and possible solutions to overcome these barriers. Results: A total of 164 pregnant women with gestational diabetes were included in the study. The age of 36.4% of them exceeded 35 years. Among personal barriers, preferring other treatment methods over insulin (56.4%) and unaware of insulin dose control method (45.4%) were commonly reported. Regarding family barriers, 23.6% reported past family experience of insulin-related complications. Concerning side effects, fear of hypoglycemia (59.4%) and fear of weight gain (50.9%) were most frequently reported barriers against use of insulin. Regarding misconceptions about insulin injections, 26% believed that insulin is addictive;the injection will continue for life. Among work-related barriers, irregular eating times during working hours and long working hours (55.2%) were barriers for insulin use. Facilitating access to healthcare services (94%), engage the patient in decision-making and development of the treatment plan (91.6%), activate virtual clinics and social media for remote follow-up (86.6%) and organize social support groups for pregnant women who use insulin to share their experiences were the most frequently reported possible solutions to initiate and commit to insulin therapy. Conclusion: Various barriers were identified against initiation of insulin therapy in the management of gestational diabetes;mostly due to personal factors, misconception and work-related factors. Prompt actions are needed to overcome these barriers.展开更多
Various studies have suggested several environmental,pharmacological,medical,and optical interventions and some are in use but their efficacy in myopia control may be transient,and the cellular,molecular,and biochemic...Various studies have suggested several environmental,pharmacological,medical,and optical interventions and some are in use but their efficacy in myopia control may be transient,and the cellular,molecular,and biochemical mechanisms involved unclear.Daylight exposure is currently regarded as an effective and enduring strategy in the control of myopia development and progression.However,the mechanism behind the effect of outdoor exposure and its association with genetic predisposition and other relatively more significant environmental factors on myopia is still a conundrum.This review focuses on survey-based and intervention-based studies carried out to propose a mechanism that accounts for myopia development and important for its control.展开更多
There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting gluco...There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting glucose and impaired glucose tolerance,is on the rise across the globe.Transplant teams frequently come across prediabetic kidney donors for evaluation.Prediabetics are at risk of diabetes,chronic kidney disease,cardiovascular events,stroke,neuropathy,retinopathy,dementia,depression and nonalcoholic liver disease along with increased risk of all-cause mortality.Unfortunately,most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period.There is lack of prospective long-term studies to know about the real risk of complications after donation.Furthermore,there are variations in recommendations from various guidelines across the globe for donations in prediabetics,leading to more confusion among clinicians.This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients.This review focuses on pathophysiological changes of PD in kidneys,potential complications of PD,other risk factors for development of type 2 diabetes,a review of guidelines for kidney donation,the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.展开更多
GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who h...GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who have failed to control their condition with other oral anti-diabetic drugs (OADs). However, GLP-1RAs are underutilized—as time patients remained on their last oral treatment regimen with inadequate glycemic control prior to GLP-1RA initiation is on average of 19 month—despite evidence supporting their effectiveness, safety, and possible CV outcome advantages. With the new advances in GLP-1 RAs, the first oral form for the semaglutide molecule was developed with proven efficacy, safety, and patient preferences that may help pave the road for more utilization of this class. Therefore, we, a Saudi task force, gathered to develop an explicit, evidence-based consensus on oral semaglutide use in Saudi patients with diabetes. The panel recommends a GLP-1RA in those T2DM patients with or without or at high risk for ASCVD, HF, and/or CKD when there is a need to minimize weight gain or promote weight loss, or when there is a need to minimize hypoglycemia. Ensure that people with T2DM and ASCVD, HF, or CKD are treated appropriately with an SGLT-2i or GLP-1 RA. This approach should be initiated independent of background therapy, glycaemic control, or individualized treatment goals. Healthcare professionals should do their best to prevent clinical inertia in T2DM to help people with T2DM achieve better glycemic control and prevent or delay diabetes-related complications. The availability of oral forms of GLP-1RA medications could help combat this problem of clinical inertia to start GLP-1RA at the right time, as patients prefer oral to injectable forms. The availability of oral GLP-1RA can help in starting this class early and encourage healthcare professionals in prescribing it at the right time. Moreover, it can help those patients who fear of the injections. The panel recommends the oral GLP-1RA semaglutide to be used early and encourage healthcare professionals in prescribing it at the right time. The injectable form can be preserved for further intensification of therapy whenever needed as add-on therapy particulary for poly-medicated patients for better compliance at this stage. .展开更多
Rupture of the anterior cruciate ligament(ACL)is a common orthopedic injury.Various graft options are available for the reconstruction of ruptured ACL.Using the hamstring muscle as an autograft was first described in ...Rupture of the anterior cruciate ligament(ACL)is a common orthopedic injury.Various graft options are available for the reconstruction of ruptured ACL.Using the hamstring muscle as an autograft was first described in 1934,and it remains a commonly harvested graft for ACL reconstruction.Hamstring autografts can be harvested using the traditional anteromedial approach or the newer posteromedial technique.An isolated semitendinosus tendon can be used or combined with the gracilis tendon.There are numerous methods for graft fixation,such as intra-tunnel or extra-tunnel fixation.This comprehensive review discusses the different hamstring muscle harvesting techniques and graft preparation options and fixation methods.It provides a comprehensive overview for choosing the optimal surgical technique when treating patients.展开更多
Aims/Introduction: There are studies in different countries regarding the prevalence of vitamin D deficiency in non diabetic population. Few studies were done in adults with type 1 diabetes mellitus. This study was co...Aims/Introduction: There are studies in different countries regarding the prevalence of vitamin D deficiency in non diabetic population. Few studies were done in adults with type 1 diabetes mellitus. This study was conducted to determine Vitamin D Status among Saudi patients with type 1 diabetes and to correlate the associated environmental risk factors. Materials and Methods: A cross-sectional single centre study was conducted in 221 Saudi patients with type 1 diabetes mellitus. These patients were recruited through the Diabetes Centre at King Fahad Armed Forces Hospital between January 2008 and June 2009. 25-hydroxy-vitamin D, Parathyroid hormone, calcium, phosphate and alkaline phosphatase were measured. Results: There were 221 patients with type 1 diabetes mellitus, 92 males (42%) and 129 females (58%). The mean age was 21.3 ± 7.2 and the mean diabetes duration was 7.5 ± 5.7. The frequency of 25-hydroxyvitamin D 50 nmol/l and <25 nmol/l were 97% and 60% respectively. The frequency of 25-hydroxyvitamin D 25 nmol/l was significantly more frequent in female. 67% were either only exposed face or totally covered. Duration of sun exposure in 64% was less than 30 minutes per day. The area of skin exposed and duration of sunlight exposure associated significantly with Vitamin D levels (p 0.0001 and p 0.0001 respectively). Age was associated with more vitamin D < 25 nmol/l (the odds ratio (95% confidence interval);4.8 (4.6,14.5), p = 0.005;5.3 (1.8,15.5), p = 0.003;3.9 (1.5,10.5), p = 0.007 for age groups 12 - 15, 16 - 19 and 20 - 24 years old consequently. Male gender and exposing face, arms and legs to sun were associated with vitamin D ≥ 25 nmol/l;the odds ratio (95% confidence interval);0.27 (0.11,0.6), p = 0.001;0.26 (0.09,0.75), p = 0.01 consequently. Conclusions:展开更多
Background: Type 1 Diabetes mellitus (T1DM) results from a cellular-mediated autoimmune destruction of the β-cells of the pancreas. We designed this study to determine the prevalence of autoantibodies among Saudis pa...Background: Type 1 Diabetes mellitus (T1DM) results from a cellular-mediated autoimmune destruction of the β-cells of the pancreas. We designed this study to determine the prevalence of autoantibodies among Saudis patients with T1DM. Methods: Glutamic acid decarboxylase antibodies (GADA), antibodies to Islet cell (ICA) and Insulin (IAA) were measured in 171 Saudis patients with T1DM. Results: There were 171 patients with T1DM, 71 males (41.5%) and 100 females (58.5%). The mean age was 20.8 ± 6.6 and the mean diabetes duration was 7.7 ± 5.7. GADA, ICA and IAA were detected in 53.8%, 32.2% and 76% respectively. GADA, ICA and IAA were nonsignificantly more frequent in female and GADA and IAA were significantly more frequent in those younger than 20 years of age. Subjects testing positive for GADA had higher levels of ICA (42.4% vs. 20.3, p = 0.003) and IAA (79.3% vs. 72.2, p = 0.3) than those negative for GADA. Multiple antibodies (≥2) were observed more often in patients under the age of 20 years. There were nonsignificant differences in the prevalence of multiple antibodies between both genders. Multiple logistic regression analysis showed a significant independent positive relationship between the serum positivity of GADA, ICA and Multiple antibodies (≥2) with diabetes duration (0.02, p = 0.03, 0.02, p = 0.01 and 0.01, p = 0.04 respectively). Conclusions: The prevalence of autoantibodies in Saudi patients with T1DM is similar to those reported for diabetic patients in other ethnic groups.展开更多
Objectives: The study was to determine the impact of using the FreeStyle Libre<sup>TM</sup> flash glucose monitoring system on glycemic control and the rate of events due to diabetes in people with diabete...Objectives: The study was to determine the impact of using the FreeStyle Libre<sup>TM</sup> flash glucose monitoring system on glycemic control and the rate of events due to diabetes in people with diabetes from different types and age groups. Methods: a retrospective cohort chart review study was carried out at three centers in the Taif region in the Kingdom of Saudi Arabia: The study was approved by an accredited centralized institutional review board. Paper or electronic medical records were included for individuals of any age with diabetes (type 1, type 2, gestational diabetes) managed with diet, insulin therapy, or/and oral antihyperglycemic medication and/or non-insulin injection therapy. The primary outcome measure was the laboratory HbA1c level as well as reduction. Secondary outcome measures were frequency of severe hypoglycemia, admission to hospital or ER visit related to diabetes complications, and severe hyperglycemia (DKA or HHS). Results: Data was analyzed from 1695 patients. The average HbA1c before using the flash glucose monitoring system was 9.60% ± 1.44% and 3 months HbA1c after using the FreeStyle Libre<sup>TM</sup> flash glucose monitoring system was 8.70% + 1.45% for a difference of -0.90% ([95% CI -0.92: -0.88];p 65 years, (p-values Conclusion: The benefits of using the FreeStyle Libre<sup>TM</sup> flash glucose monitoring system are self-evident in reducing HbA1c and events due to hyperglycemia or hypoglycemia.展开更多
Dear Dr. Martin Hovland, We learned from the literature that premixed insulins are short-acting insulin or rapid-acting insulin analogue mixed with intermediate-acting insulin in a fixed ratio, addressing FBG and PPBG...Dear Dr. Martin Hovland, We learned from the literature that premixed insulins are short-acting insulin or rapid-acting insulin analogue mixed with intermediate-acting insulin in a fixed ratio, addressing FBG and PPBG in one injection. There are two categories;high-mix and low-mix premixed insulins. We, a Saudi task force, gathered to develop an explicit, evidence-based consensus for the use of the low-mix premixed insulin for better glycemic control. The treatment with premixed aspart 30 was non-inferior to treatment with premixed insulin lispro 25. In addition, Self-monitored blood glucose levels were comparable. Safety profiles were similar between both treatments, as was the incidence of hypoglycemic episodes. The switch between both products of the low-mix family can be carried out without any problem. Both products of the low-mix premixed insulin analogues aspart 30/70 and premixed insulin lispro 25/75 have comparable efficacy and safety as shown from the medical literature. Therefore, we can change from one to another safely as demonstrated by the US FDA statement. In addition, the ergonomic features of KwikPen’s design and function may offer important advantages for the user during insulin administration.展开更多
文摘Background: Gestational diabetes mellitus (GDM) is one of the most common pathologies in pregnancy. Unfortunately, both clinicians and patients are often reluctant to begin insulin therapy, a phenomenon that has been known as psychological insulin resistance (PIR). Objectives: To assess the barriers of initiating insulin among GDM pregnant women. Patients and Methods: An observational cross-sectional study was conducted in the GDM clinic, Diabetes Center in Hera’a General Hospital, Makkah, Saudi Arabia in a period of 4 months. A self-administered validated questionnaire was adopted. It included socio-demographic data of women, perceived (personal, social, pharmacological, occupational and misconception) barriers towards insulin therapy and possible solutions to overcome these barriers. Results: A total of 164 pregnant women with gestational diabetes were included in the study. The age of 36.4% of them exceeded 35 years. Among personal barriers, preferring other treatment methods over insulin (56.4%) and unaware of insulin dose control method (45.4%) were commonly reported. Regarding family barriers, 23.6% reported past family experience of insulin-related complications. Concerning side effects, fear of hypoglycemia (59.4%) and fear of weight gain (50.9%) were most frequently reported barriers against use of insulin. Regarding misconceptions about insulin injections, 26% believed that insulin is addictive;the injection will continue for life. Among work-related barriers, irregular eating times during working hours and long working hours (55.2%) were barriers for insulin use. Facilitating access to healthcare services (94%), engage the patient in decision-making and development of the treatment plan (91.6%), activate virtual clinics and social media for remote follow-up (86.6%) and organize social support groups for pregnant women who use insulin to share their experiences were the most frequently reported possible solutions to initiate and commit to insulin therapy. Conclusion: Various barriers were identified against initiation of insulin therapy in the management of gestational diabetes;mostly due to personal factors, misconception and work-related factors. Prompt actions are needed to overcome these barriers.
文摘Various studies have suggested several environmental,pharmacological,medical,and optical interventions and some are in use but their efficacy in myopia control may be transient,and the cellular,molecular,and biochemical mechanisms involved unclear.Daylight exposure is currently regarded as an effective and enduring strategy in the control of myopia development and progression.However,the mechanism behind the effect of outdoor exposure and its association with genetic predisposition and other relatively more significant environmental factors on myopia is still a conundrum.This review focuses on survey-based and intervention-based studies carried out to propose a mechanism that accounts for myopia development and important for its control.
文摘There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting glucose and impaired glucose tolerance,is on the rise across the globe.Transplant teams frequently come across prediabetic kidney donors for evaluation.Prediabetics are at risk of diabetes,chronic kidney disease,cardiovascular events,stroke,neuropathy,retinopathy,dementia,depression and nonalcoholic liver disease along with increased risk of all-cause mortality.Unfortunately,most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period.There is lack of prospective long-term studies to know about the real risk of complications after donation.Furthermore,there are variations in recommendations from various guidelines across the globe for donations in prediabetics,leading to more confusion among clinicians.This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients.This review focuses on pathophysiological changes of PD in kidneys,potential complications of PD,other risk factors for development of type 2 diabetes,a review of guidelines for kidney donation,the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.
文摘GLP-1 receptor agonists (GLP-1 RAs) are among the most successful medications for treating people with type 2 diabetes mellitus (T2DM), giving reasonable glycemic control with a low risk of hypoglycemia in those who have failed to control their condition with other oral anti-diabetic drugs (OADs). However, GLP-1RAs are underutilized—as time patients remained on their last oral treatment regimen with inadequate glycemic control prior to GLP-1RA initiation is on average of 19 month—despite evidence supporting their effectiveness, safety, and possible CV outcome advantages. With the new advances in GLP-1 RAs, the first oral form for the semaglutide molecule was developed with proven efficacy, safety, and patient preferences that may help pave the road for more utilization of this class. Therefore, we, a Saudi task force, gathered to develop an explicit, evidence-based consensus on oral semaglutide use in Saudi patients with diabetes. The panel recommends a GLP-1RA in those T2DM patients with or without or at high risk for ASCVD, HF, and/or CKD when there is a need to minimize weight gain or promote weight loss, or when there is a need to minimize hypoglycemia. Ensure that people with T2DM and ASCVD, HF, or CKD are treated appropriately with an SGLT-2i or GLP-1 RA. This approach should be initiated independent of background therapy, glycaemic control, or individualized treatment goals. Healthcare professionals should do their best to prevent clinical inertia in T2DM to help people with T2DM achieve better glycemic control and prevent or delay diabetes-related complications. The availability of oral forms of GLP-1RA medications could help combat this problem of clinical inertia to start GLP-1RA at the right time, as patients prefer oral to injectable forms. The availability of oral GLP-1RA can help in starting this class early and encourage healthcare professionals in prescribing it at the right time. Moreover, it can help those patients who fear of the injections. The panel recommends the oral GLP-1RA semaglutide to be used early and encourage healthcare professionals in prescribing it at the right time. The injectable form can be preserved for further intensification of therapy whenever needed as add-on therapy particulary for poly-medicated patients for better compliance at this stage. .
文摘Rupture of the anterior cruciate ligament(ACL)is a common orthopedic injury.Various graft options are available for the reconstruction of ruptured ACL.Using the hamstring muscle as an autograft was first described in 1934,and it remains a commonly harvested graft for ACL reconstruction.Hamstring autografts can be harvested using the traditional anteromedial approach or the newer posteromedial technique.An isolated semitendinosus tendon can be used or combined with the gracilis tendon.There are numerous methods for graft fixation,such as intra-tunnel or extra-tunnel fixation.This comprehensive review discusses the different hamstring muscle harvesting techniques and graft preparation options and fixation methods.It provides a comprehensive overview for choosing the optimal surgical technique when treating patients.
文摘Aims/Introduction: There are studies in different countries regarding the prevalence of vitamin D deficiency in non diabetic population. Few studies were done in adults with type 1 diabetes mellitus. This study was conducted to determine Vitamin D Status among Saudi patients with type 1 diabetes and to correlate the associated environmental risk factors. Materials and Methods: A cross-sectional single centre study was conducted in 221 Saudi patients with type 1 diabetes mellitus. These patients were recruited through the Diabetes Centre at King Fahad Armed Forces Hospital between January 2008 and June 2009. 25-hydroxy-vitamin D, Parathyroid hormone, calcium, phosphate and alkaline phosphatase were measured. Results: There were 221 patients with type 1 diabetes mellitus, 92 males (42%) and 129 females (58%). The mean age was 21.3 ± 7.2 and the mean diabetes duration was 7.5 ± 5.7. The frequency of 25-hydroxyvitamin D 50 nmol/l and <25 nmol/l were 97% and 60% respectively. The frequency of 25-hydroxyvitamin D 25 nmol/l was significantly more frequent in female. 67% were either only exposed face or totally covered. Duration of sun exposure in 64% was less than 30 minutes per day. The area of skin exposed and duration of sunlight exposure associated significantly with Vitamin D levels (p 0.0001 and p 0.0001 respectively). Age was associated with more vitamin D < 25 nmol/l (the odds ratio (95% confidence interval);4.8 (4.6,14.5), p = 0.005;5.3 (1.8,15.5), p = 0.003;3.9 (1.5,10.5), p = 0.007 for age groups 12 - 15, 16 - 19 and 20 - 24 years old consequently. Male gender and exposing face, arms and legs to sun were associated with vitamin D ≥ 25 nmol/l;the odds ratio (95% confidence interval);0.27 (0.11,0.6), p = 0.001;0.26 (0.09,0.75), p = 0.01 consequently. Conclusions:
文摘Background: Type 1 Diabetes mellitus (T1DM) results from a cellular-mediated autoimmune destruction of the β-cells of the pancreas. We designed this study to determine the prevalence of autoantibodies among Saudis patients with T1DM. Methods: Glutamic acid decarboxylase antibodies (GADA), antibodies to Islet cell (ICA) and Insulin (IAA) were measured in 171 Saudis patients with T1DM. Results: There were 171 patients with T1DM, 71 males (41.5%) and 100 females (58.5%). The mean age was 20.8 ± 6.6 and the mean diabetes duration was 7.7 ± 5.7. GADA, ICA and IAA were detected in 53.8%, 32.2% and 76% respectively. GADA, ICA and IAA were nonsignificantly more frequent in female and GADA and IAA were significantly more frequent in those younger than 20 years of age. Subjects testing positive for GADA had higher levels of ICA (42.4% vs. 20.3, p = 0.003) and IAA (79.3% vs. 72.2, p = 0.3) than those negative for GADA. Multiple antibodies (≥2) were observed more often in patients under the age of 20 years. There were nonsignificant differences in the prevalence of multiple antibodies between both genders. Multiple logistic regression analysis showed a significant independent positive relationship between the serum positivity of GADA, ICA and Multiple antibodies (≥2) with diabetes duration (0.02, p = 0.03, 0.02, p = 0.01 and 0.01, p = 0.04 respectively). Conclusions: The prevalence of autoantibodies in Saudi patients with T1DM is similar to those reported for diabetic patients in other ethnic groups.
文摘Objectives: The study was to determine the impact of using the FreeStyle Libre<sup>TM</sup> flash glucose monitoring system on glycemic control and the rate of events due to diabetes in people with diabetes from different types and age groups. Methods: a retrospective cohort chart review study was carried out at three centers in the Taif region in the Kingdom of Saudi Arabia: The study was approved by an accredited centralized institutional review board. Paper or electronic medical records were included for individuals of any age with diabetes (type 1, type 2, gestational diabetes) managed with diet, insulin therapy, or/and oral antihyperglycemic medication and/or non-insulin injection therapy. The primary outcome measure was the laboratory HbA1c level as well as reduction. Secondary outcome measures were frequency of severe hypoglycemia, admission to hospital or ER visit related to diabetes complications, and severe hyperglycemia (DKA or HHS). Results: Data was analyzed from 1695 patients. The average HbA1c before using the flash glucose monitoring system was 9.60% ± 1.44% and 3 months HbA1c after using the FreeStyle Libre<sup>TM</sup> flash glucose monitoring system was 8.70% + 1.45% for a difference of -0.90% ([95% CI -0.92: -0.88];p 65 years, (p-values Conclusion: The benefits of using the FreeStyle Libre<sup>TM</sup> flash glucose monitoring system are self-evident in reducing HbA1c and events due to hyperglycemia or hypoglycemia.
文摘Dear Dr. Martin Hovland, We learned from the literature that premixed insulins are short-acting insulin or rapid-acting insulin analogue mixed with intermediate-acting insulin in a fixed ratio, addressing FBG and PPBG in one injection. There are two categories;high-mix and low-mix premixed insulins. We, a Saudi task force, gathered to develop an explicit, evidence-based consensus for the use of the low-mix premixed insulin for better glycemic control. The treatment with premixed aspart 30 was non-inferior to treatment with premixed insulin lispro 25. In addition, Self-monitored blood glucose levels were comparable. Safety profiles were similar between both treatments, as was the incidence of hypoglycemic episodes. The switch between both products of the low-mix family can be carried out without any problem. Both products of the low-mix premixed insulin analogues aspart 30/70 and premixed insulin lispro 25/75 have comparable efficacy and safety as shown from the medical literature. Therefore, we can change from one to another safely as demonstrated by the US FDA statement. In addition, the ergonomic features of KwikPen’s design and function may offer important advantages for the user during insulin administration.
