Recently, a review article by the team led by Professors Guo Lixin and Pan Qi from Beijing Hospital was published in the journal Aging Med (Milton), interpreting the Chinese Guidelines for the Diagnosis and Treatment of Diabetes in the Elderly (2024 Edition). The review focuses on the principles, clinical benefits and application challenges of relevant technologies, aiming to improve the long-term prognosis of elderly patients with diabetes. The first author of the article is Dr. Cai Qingyun from Peking Union Medical College.
Injection-related complications and fear of needles are key factors affecting insulin treatment adherence in elderly patients. The advent of needle-free injectors has significantly addressed many challenges faced by elderly diabetic patients.
Needle-free insulin injection uses pressure sources such as gas, electromagnetic force or springs to generate a transient high-pressure pulse, which delivers insulin as a high-speed jet through a tiny nozzle onto the skin surface, where it rapidly penetrates and diffuses into subcutaneous tissue, resulting in a fast onset of action.
This delivery method reduces anxiety caused by traditional needle injections, relieves injection pain, lowers the risk of needle-related adverse reactions, and ultimately improves patient treatment adherence.
Needle-free insulin injection has been recommended as one of the insulin administration methods in the Chinese Guidelines for the Diagnosis and Treatment of Diabetes in the Elderly (2024 Edition).
Compared with conventional needle injection, needle-free injection can more effectively improve fasting and 24-hour overall glycemic control, reduce blood glucose peaks and glycemic variability. It features faster insulin absorption and shorter time to peak concentration, which helps improve early postprandial glycemia. It has potential advantages especially for elderly patients at risk of immediate postprandial hyperglycemia and late hypoglycemia.
Meanwhile, needle-free injection can reduce insulin dosage while maintaining glycemic control, and is not affected by differences in skin thickness. Since no needles are required, this technology has obvious advantages in reducing pain and improving treatment experience, and is also recommended in the Chinese Diabetes Injection Guidelines.
However, as a relatively new delivery technology, evidence-based data for needle-free injection in the elderly diabetic population remains limited. Most current related studies are small-sample and short-term follow-up, and its impact on chronic complications and long-term prognosis is unclear.
In addition, needle-free injectors are relatively complex to operate and require professional guidance. The high cost of equipment and consumables, as well as limited medical insurance coverage, have restricted its widespread use in elderly patients to a certain extent, especially those in economically underdeveloped areas.