***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The goal of this study was to compare the efficacy and safety profiles of biphasic insulin aspart 30 ( 30 % soluble insulin aspart and 70 % protaminated insulin aspart [ BIAsp 30 ] ) and biphasic insulin lispro 25 ( 25 % soluble insulin lispro and 75 % neutral protamine lispro [ Mix25 ] ) used in a BID injection regimen in patients with type 2 diabetes mellitus ( DM ) . Also assessed was patients ' preference for pen device -- the NovoMix 30 FlexPen /NovoLog Mix 70/30 FlexPen ( FlexPen ) versus the Humalog Mix25 Pen/Humalog Mix75/25 Pen ( Humalog Pen ) . METHODS Patients with type 2 DM receiving current insulin treatment were r and omized to a multinational , multicenter , open-label , 2-period , crossover comparison of BIAsp 30 and Mix25 .  Efficacy ( by analyses of variance ) and safety profiles were assessed after 12 weeks of treatment . Patients ' preference for pen device was assessed by question naires . RESULTS A total of 137 patients were r and omized to treatment ; 4 were withdrawn during the 2-week run-in treatment with biphasic human insulin 30 . The mean ( SD ) characteristics of the remaining 133 patients ( 79 men , 54 women ) were as follows : age , 62.3 ( 9.2 ) years ; body mass index , 28.1 ( 3.9 ) kg/m(2 ) ; and glycosylated hemoglobin ( HbA(1c ) ) , 8.5 % ( 1.1 ) . Glycemic control was assessed by the measurement of HbA(1c ) after 12 weeks of treatment . Treatment with BIAsp 30 was noninferior to treatment with Mix25 ( upper limit of 90 % CI for estimated difference [ BIAsp 30 - Mix25 ] was < 0.4 % ) . Self-monitored blood glucose levels were comparable ( P = NS ) . Adverse-event profiles were similar between treatments , as was the incidence of hypoglycemic episodes ( 0.69 episode/mo with BIAsp 30 and 0.62 episode/mo with Mix25 , P = 0.292 ) . For all device features assessed , the FlexPen consistently received higher scores ( all P < 0.005 ) . A total of 9.0 % of patients experienced problems with the FlexPen , compared with 32.4 % with the Humalog Pen ( P < 0.001 ) . Furthermore , 74.6 % preferred to continue using the FlexPen , whereas 14.3 % preferred the Humalog Pen ( P < 0.001 ) . CONCLUSIONS In this study , glycemic control with BIAsp 30 and Mix25 was found to be comparable in these patients with type 2 DM .  Safety profiles were similar for both regimens . Patients preferred and experienced fewer problems with the FlexPen than the Humalog Pen BACKGROUND Adalimumab is a therapeutic monoclonal antibody for SC administration by 2 single-use injection devices providing bioequivalent amounts of adalimumab : a ready-to-use , prefilled syringe and an integrated , disposable delivery system , the autoinjection Pen . Although pens have been shown to be preferred over syringes by patients requiring long-term SC administration of medications , there are no data on preference and pain in the use of biologics in patients with chronic inflammatory diseases . OBJECTIVE The aim of this study was to assess injection-site pain , tolerability , and patient preference of 2 delivery systems of adalimumab . METHODS Patients with rheumatoid arthritis were enrolled in a Phase II , multicenter , open-label , single-arm , sequential trial . Patients self-administered a st and ard dose of adalimumab 40 mg SC every other week at each of 3 monitored clinical visits : visit 1 ( syringe ) , visits 2 and 3 ( Pen ) . At each visit , patients rated their pain on an 11-point scale ( 0 = none to 10 = pain as bad as it could be ) immediately after injection and 15 - 30 minutes after injection and provided their impressions of and preferences for each delivery system . Safety events were recorded throughout the study and 70 days after final study dose . RESULTS Fifty-two patients were enrolled in the trial and completed all 3 visits ( 32 women , 20 men ; mean [ SD ] age , 53.8 [ 12.1 ] years ) . Forty ( 76.9 % ) patients reported that the Pen was less painful than the syringe , 4 ( 7.7 % ) patients found the syringe to be less painful , and 8 ( 15.4 % ) patients had no preference . Patients had statistically significant reductions in injection-pain scores from visit 1 to visit 2 and from visit 1 to visit 3 . No new safety signals or apparent differences regarding tolerability between the syringe and Pen were observed . In addition , 46 ( 88.5 % ) patients preferred the Pen , 3 ( 5.8 % ) preferred the syringe , and 3 ( 5.8 % ) had no preference . Overall , patients evaluated the Pen as easier to use ( 94.2 % ) , more convenient ( 92.3 % ) , requiring less time to inject ( 82.7 % ) , and safer ( 88.5 % ) . CONCLUSIONS Patients experienced less pain self-administering adalimumab via the Pen and preferred it versus the syringe . Further , patients perceived the Pen to be easier to use and more convenient . Both delivery systems were generally well tolerated ABSTRACT Background : Diabetes mellitus ( DM ) affects over 18.2 million Americans and diabetes-related medical costs exceed 132 billion dollars per year , totaling more than 12 % of the United States healthcare budget . The Diabetes Control and Complications Clinical Trial demonstrated that intensive insulin therapy and the control of plasma glucose can significantly reduce the incidence of late diabetic complications and delay the progression of existing conditions in type 1 diabetes . Optimal glycemic control often requires intensive insulin therapy to maintain a hemoglobin A1C ( A1C ) of less than 7 % as recommended by the American Diabetes Association . It is estimated that more than half of the approximately 7 million Americans using insulin do so with suboptimal treatment and while administering one or two insulin injections per day . Non-adherence may be a contributing factor in suboptimal treatment . For a variety of reasons , many patients diagnosed with diabetes and treated with insulin are non-adherent . Scope : The primary objective of this study was to evaluate preference for an insulin delivery system comparing a disposable doser ( InnoLet ) to the st and ard vial/syringe . In a prospect i ve , r and omized , open-label , two-period , crossover study , 260 patients were enrolled ( age ≥ 18 years , with type 1 or 2 diabetes , and receiving NPH or regular or 70/30 insulin for at least 6-months ) . A total of 162 patients completed both treatment arms . Excluded were those unable to read/write English or administer their own injections , pregnant/lactating women , those using antipsychotics , and those with a history of alcohol abuse or cognitive impairment . Patients completed the eight-item Diabetes Fear of Self-Injection Question naire at baseline , week 12 and week 24 . Items were rated on a 4-point Likert scale ( 1 = almost never ; 4 = almost always ) with a maximum fear score of 32 . At week 24 , patients completed a preference survey . Findings : Of the 162 patients completing both treatment arms , 89 ( 55.0 % ) were in the vial/syringe to disposable doser treatment arm , 50 % were female and mean age was 60 ± 11 years . Patients in both treatment arms displayed little significant differences in baseline characteristics . Patients reported significantly lower fear of self-injection after using the disposable doser compared to vial/syringe ( mean ± SEM : 9.5 ± 0.2 vs. 11.2 ± 0.4 ; p < 0.0001 ) . Most patients ( 71.5 % ) indicated a preference for the disposable doser compared to the vial/syringe method ( p < 0.0001 ) . Conclusion : The majority of patients preferred the disposable doser , and reported significantly less fear of self-injection using this delivery system . There are some potential limitations to consider . A r and omization bias may have been present , patients who enrolled in this study were those who were actively seeking medical treatment for diabetes , insulin pens and cartridges are not available for all types of insulin regimens , pre-filled pens and cartridges may not be altered and , in general , alternative insulin delivery systems tend to be more costly than insulin sold in traditional vials . However , insulin may have greater patient acceptance and less psychological distress when administered via an alternative delivery system BACKGROUND Because the use of insulin therapy can place a substantial burden on patients with diabetes , insulin administration should be as simple as possible . OBJECTIVES The primary aim of this trial was to compare the use of 2 insulin delivery devices-one prefilled ( NovoMix 30 FlexPen [ FP ] ; Novo Nordisk , Copenhagen , Denmark ) and the other reusable ( HumaPen Luxura [ HL ] ; Eli Lilly and Company , Indianapolis , Indiana)-in patients with type 2 diabetes in terms of intuitiveness and training time . A secondary aim was to evaluate the ease of use and overall acceptance of the 2 devices . METHODS This was a r and omized , open-label , comparative , crossover h and ling study in adult patients with type 2 diabetes who had been treated with oral antidiabetic drugs for > or=2 years and had no previous experience with insulin injection devices . Patients were r and omly allocated to the intuitiveness group ( no instruction in the use of the devices provided ) or the instruction group ( instruction provided ) . The time taken to deliver an injection into a cushion was measured for each device in both groups . Patients answered question naires concerning the intuitiveness and ease of use of the 2 devices , their trust and confidence in the devices to deliver the insulin dose , and their overall pen preference . RESULTS Sixty-one patients were enrolled in the study ( 70.5 % male ; mean [ SD ] age , 61.80 [ 7.60 ] years ) , 30 in the intuitiveness group and 31 in the instruction group . When all h and ling steps for the HL device were included , the mean ( SD ) injection time was significantly shorter for the FP device compared with the HL device in the intuitiveness group ( 1.21 [ 1.04 ] vs 1.74 [ 0.79 ] minutes , respectively ; P = 0.035 ) . The outcome was similar in the instruction group ( 0.71 [ 0.29 ] vs 1.09 [ 0.49 ] minutes ; P < 0.001 ) . When the time for cartridge insertion in the HL device was excluded , there was no significant difference in injection time for the respective devices in either group ( intuitiveness group : 1.21 [ 1.04 ] and 1.07 [ 0.91 ] minutes ; instruction group : 0.63 [ 0.35 ] and 0.71 [ 0.29 ] minutes ) . Twenty-two patients preferred the FP device in terms of ease of learning , compared with 8 patients preferring the HL device ( P = 0.007 ) . CONCLUSIONS In this study , when all h and ling steps were included , the FP device was associated with significantly greater intuitiveness and a shorter injection time compared with the HL device . Further research is needed to determine whether these differences between devices are clinical ly meaningful OBJECTIVE Effects of pump treatment vs. four times daily injections were explored in children with diabetes with regard to quality of life and impact of disease as well as adverse effects and parameters of metabolic control . METHODS An open , parallel , r and omized controlled prospect i ve comparative study lasting 14 months was completed by 38 type 1 children with diabetes ( age 4 - 16 yr ) following a 3.5-months run-in phase . St and ardized quality -of-life Pediatric Quality of life Inventory ( PedsQL ) and impact of disease scores were obtained every 3.5 months as well as regular medical parameters . Parallel treatment group data and longitudinal within-patient data were analysed for each treatment modality . RESULTS Within-patient comparisons of the two treatment modalities showed significant improvement in PedsQL and impact scores after pump treatment . Treatment group comparisons did not show significant improvement . Pump treatment result ed in decreased symptomatic hypoglycaemia and lowered haemoglobin A1c by 0.22 % after run in . CONCLUSIONS Within-patient comparison suggests that metabolic control , frequency of severe hypoglycaemia ( a threefold decrease ) , quality of life and impact of disease scores are improved by pump treatment in comparison to regular treatment with four daily insulin injections OBJECTIVE To assess the acceptability , utility , and tolerability of a system of stratified care of acute migraine  using multiple formulations of sumatriptan . BACKGROUND Stratified care matches the treatment of a disease to its level of severity . Sumatriptan , with its multiple formulations , seems a logical option in a stratified care approach . Little data exists on the use of multiple formulations in a single patient population . DESIGN AND METHODS A prospect i ve , open-label , outpatient study recruited patients from a single center during the period from January 1998 through June 199 
    Output:
    
Pen devices and autoinjectors were favored over administration with needle and syringe , particularly with respect to ergonomics , convenience , and portability .
Inhalation appeared to be more acceptable than subcutaneous injection ( in the case of insulin ) , but how subcutaneous infusion , intramuscular injection , and needle-free injection devices compare with subcutaneous injections in terms of patient preference is less certain .
Conclusions The review identified a number of studies showing the importance of the methods and routes of drug delivery on patient choice .