The injection experience is an often-overlooked aspect in insulin administration. For many daily insulin users, the experience is an important one, as it is directly related to quality of life and medication compliance. It is inaccurate to assume that one “just gets used to” the poke of a daily needle, as more often than not, this is not the case.
In fact, research suggests that 94 percent of insulin injectors experience anxiety and distress due to triggers associated with daily injections; these include seeing the needle, anticipation of the injection and the injection itself.
Keeping the user experience at the forefront in the design of their insulin delivery device, experts at HTL-STREFA, a subsidiary of MTD Medical Technology and Devices SA, have engineered the world’s shortest and thinnest insulin needle. Known as Droplet Micron, the needle measures just 34 gauge by 3.5 mm, offering a less painful and comfortable injection experience. Traditional needles on the market range between 8 and 12.5 mm in length, with the shortest available being 4 mm, and gauges between 28 and 31 gauge (the higher the gauge value, the thinner the needle).
Carl Ward, GM at HTL-STREFA, explained the gravity of a type 1 diabetes diagnosed. He recounted a personal experience of how a friend was caught up in emotion over his 14-year-old daughter’s type 1 diabetes diagnosis as he turned to Ward for information and assistance.
Ward says his friend had questions like, “Is she going to make it to her wedding? Is she going to have a baby?” He says, “You don’t realize these are the things that go through people’s mind.”
And it’s the patient and human stories like these that have helped drive the innovation behind Droplet Micron.
“People oftentimes are looking for support. They’re looking for someone that can be in their camp,” says Ward, “because they say this is so overwhelming.”
Ward says that the numbers that those with diabetes, and their caregivers, need to keep track of adds to feelings of overwhelm. A1c levels, glucose levels, insulin units and carb counts are all important numbers to know in order to properly manage the disease.
However, “People say, ‘I don’t want to be a number, I’m a human being.’”
“We spend a lot of time trying to understand the human elements associated with it. What we try to do is position ourselves as being an organization that is in their camp, to let people know that they’re not having to go fight this condition all by themselves. There are people like us to help them battle and manage this condition,” says Ward.
Type 1 diabetes is not like other chronic conditions such as hypertension or hyperlipidemia, which people can start to manage early given risk factors like family history and weight, and that can be managed much more effectively with drugs and advances in drug delivery.
Unmet Need in Type 1 Diabetes Care
The founding of HTL-STREFA was spurred by an unmet need in the industry where new legislation in North America and Europe dictated that caregivers had to use a safety sharp for capillary blood collection, in the form of a safety syringe or a safety lancing device.
However, at the time, safety lancets did not exist. And this was what led to the genesis of the company. HTL-STREFA became the inventor of the first safety lancet to fulfill the unmet need, and remain worldwide leaders of safety lancets several years later.
With this mission, the company then turned to insulin injection, trying to find a way to design a less painful needle to improve the injection experience. Through some research, Ward explains they were surprised that even folks that are ‘experienced injectors’ were not faring too well.
“We asked them what it’s like, and they put on a brave face and say it’s no big deal, we’ve gotten used to it. That’s what they say on the surface, but when you probe a little bit, what you start to appreciate is that they’ve resigned themselves to the fact that nothing can be done. The pain is part of the condition, that prick, sensation, anxiety and sense of tightening up,” says Ward.
However, he notes that when patients find out there are other options, they get excited about the possibility of an alternative that could relieve that mental load and mental burden.
Therefore, the impetus for HTL-STREFA was to provide something to fulfill this unmet need and offer a solution to patients that “just want the injection to feel like nothing.” Although most patients may not believe this is possible, it is still something that they wish for.
Anu Rajora, director of medical marketing at HTL-STREFA and a pharmacist by training, says, “Patients try very hard to stick to the regimen of their [treatment] course. They’re doing their part, they know it’s important to take their medications, they’re trying to stay on top of everything to manage their condition.”
As such, she says, “Our feeling is that if they’re working so hard at managing their condition, the technology should help them. It should not inhibit, or be a barrier to doing the right thing, which is what they’re already doing [by] injecting their medicine.”
Rajora explains that this was the motivation behind bringing Droplet Micron to the market — “to show that there can be a technology that will not be a hindrance. It’s not going to cause that potential level of anxiety or discomfort. There would be a technology in their camp, so as they’re remembering to take their dose, they don’t have to worry about the experience as much.”
Insulin Needle Design and Technology
HTL-STREFA is an original manufacturer and is at the helm of every step in the design and manufacturing of its products, including sourcing raw materials such as the steel ribbon used to make needles, and the technology used to optimize design and function.
The innovation behind Droplet Micron was to see how thin it could be made — while still getting drug through — and how short it could be made to ensure that the drug is delivered in the appropriate location in the subcutaneous layer.
To create the needle, the steel ribbon is soldered along its length to create a tube that is then put under tremendous amounts of pressure, pulling it out to resemble an extremely thin guitar string, which can be as thin as an eyelash. The center of that has to be cored and beveled for liquids to be able to pass through effectively. This has involved years of technical inquiry and experience on the part of scientists and engineers at the company to optimize the design and technology that would allow for this.
Ward says this “know-how-ness is very rare and only a few companies in the world know how to do [it].”
He says that while the initial introduction of a 32 gauge and 4 mm needle was a big step forward in injection technology, there’s been no innovation in this category for over 20 years.
But with greater emphasis on patient centricity and user experience now, “it really comes down to listening to that patient with diabetes, understanding that there is still an opportunity in the injection experiences and how we as manufacturers take that responsibility and stretch the innovation so that we’re helping these patients.”
Rajora says, “Being at HTL as a healthcare professional, I really respect and am humbled by the passion that every person at the organization has, and that passion drives how we can help people with their healthcare.”
She adds that, “More [than] a mission or drive to help people, it’s also this sense of responsibility. As an original manufacturer and a market leader, we also feel a sense of responsibility to take the technology and stretch it to the capability where it’s still safe and reliable, but also helps patients with their unmet needs.”
Improving the Injection Experience
Droplet Micron was developed with the understanding that injections are more than just a moment.
There is a whole cycle involved in the injection process and being able to recognize that process for someone with diabetes is important. This involves anticipating and preparing for the injection, administering the medication, the actual injection and then repeating that cycle on a daily basis.
Rajora says, “Micron is in their corner and our focus is to help patients in terms of designing the product to deliver the best injection experience at every injection, every time.”
The injection experience and cost of needles are among the top factors that help determine patient experience and adherence. In fact, Rajora says that with respect to adherence data, injection experience comes out on top followed by the cost of managing the condition.
Droplet Micron was brought to market to address both of these challenges. Therefore, it’s about improving the injection experience at a price that is not going to cost as much as competitors. In this way, patients can get the best innovation at a lower price and that is covered by the vast majority of insurance plans across North America.
Droplet Micron was first launched in Italy and has been on the market for more than a year now. Rajora says there has been a lot of positive reception from both healthcare professionals as well as patients. Studies comparing Droplet Micron versus other products in the market have so far yielded promising results.
In the end, it’s all about the outcome, says Rajora. “It comes down to, do you see effective control of blood sugars? And you do. From a clinician’s standpoint, there is a lot of confidence you can hold [in the product].”
Seeing is Believing, and Feeling
Rajora and Ward say that it is both about seeing and feeling the difference. The needle is remarkably thinner and shorter than conventional needles, and as such, its visual appearance alone elicits a strong response.
Ward says, “Seeing is part of the experience. If you can barely see it, that sense of intimidation starts to come down.”
And what you see is what you feel.
Rajora says, “Because Micron addresses every aspect of the injection experience, it’s not just about that moment of injection, it’s about the visual stimulus of the needle, it’s about that anticipation. There is a physical reaction to anticipation, which is pain.”
Ward and Rajora, and the entire team at HTL-STREFA, are passionate about being advocates for patients through the tools that they develop.
Ward says, “It’s part of our overall mission, which is to drive innovation by leveraging technologies so that the patient has a better experience. Whether it’s an injection experience or a blood sampling experience, it’s all around this area of pushing innovation.”
Rajora says, “We stand at this place of authentic empathy and our responsibility and capacity is to use technology to better support injection experiences.”
And Ward says, “If you do the right thing, all the other things downstream will come. Just have confidence that you’re focusing on the patient and the caregiver and over time, all the other things will fall into place. If the patient votes for our product, our share price will go up and our shareholders will be happy. But it [starts with] patient centricity.”
There are various stakeholders in patients’ lives and it is important to engage them in diabetes care and management. Ward says these stakeholders “can be the real catalyst to converting patients to this product.” They can be diabetes educators in the early days of management, or pharmacists who routinely fill prescriptions that can switch patients from one product to another (in Canada, and in some states in the US). It is important to engage and educate these stakeholders so they can understand the benefit and advocate for patients by introducing the product to them.
In the end, Ward says, “I think it’s important that caregivers and patients understand that there is an alternative in the marketplace and that they should either advocate for their patients or for themselves (if they are the patient) to try the product. And we believe that if you try the product, the product will speak for itself. They should seek samples and hopefully say, ‘my gosh, it feels like nothing.’”
With a focus on helping patients through innovation and design, Droplet Micron truly aims to deliver the best injection experience, every time.