Efficacy, safety, and patient-centered outcomes of needle-free injectors versus insulin pens in diabetes management: a comprehensive meta-analysis

To evaluate the comparative effectiveness, safety, and patient acceptance of needle-free injectors and insulin pens through a meta-analysis. A thorough literature search was performed across multiple databases, including CNKI, the Weipu Database, the Wanfang Database, PubMed, Embase, and The Cochrane Library for randomized controlled trials (RCTs) on the use of needle-free injectors and insulin pens in diabetes treatment, with a time frame from database inception until June 2024. Five researchers carefully screened the literature in accordance with the inclusion and exclusion criteria, assessed study quality with validated tools and conducted the meta-analysis using RevMan 5.4. This study included 22 publications encompassing 22 studies, involving a total of 2,580 patients, with 1,290 in the needle-free group and 1,290 in the insulin pen group. The findings suggest that needle-free injectors were superior to insulin pens in improving treatment efficacy, local adverse reactions, and increasing patient acceptability, with statistically significant differences. However, no significant variations were observed in continuous glucose monitoring. Needle-free injectors can improve certain aspects of glycemic control, such as reducing HbA1c, FPG, and 2hPPG; improve local adverse reactions and increase patient acceptability. However, improvements in glycemic variability metrics were not statistically significant, indicating that further research is needed to fully assess their long-term safety and therapeutic effectiveness. In terms of systemic safety, the risk of hypoglycemia in the needle-free group was not significantly different from that in the needle group (<i>P</i> = 0.14). Additionally, our publication bias analysis revealed potential biases in the outcomes related to hypoglycemia and insulin dosage.