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Record W4409114571 · doi:10.1016/j.mayocp.2025.01.004

Advance Insulin Injection Technique and Education With FITTER Forward Expert Recommendations

2025· review· en· W4409114571 on OpenAlexafffund
David C. Klonoff, Lori Berard, Denise Reis Franco, Sandro Gentile, Zanariah Hussein, Akshay Jain, Henry Anhalt, Julia K. Mader, Eden Miller, Miguel Omeara, Michelle Robins, Felice Strollo, Hirotaka Watada, Lutz Heinemann

Bibliographic record

VenueMayo Clinic Proceedings · 2025
Typereview
Languageen
FieldMedicine
TopicDiabetes Management and Research
Canadian institutionsUniversity of British ColumbiaPrairie Improvement Network
FundersJanssen PharmaceuticalsDaiichi Sankyo CompanyEli Lilly JapanMSD K.K.Bausch HealthMitsubishi Tanabe Pharma CorporationHLS TherapeuticsRoche Diabetes CareMedizinische Universität GrazPfizerInsulet CorporationModernaChandigarh UniversityKarl-Franzens-Universität GrazSamsungUniversidad del RosarioAstraZenecaUniversidad El BosqueNovo NordiskDexcomAboca S.p.A. Società AgricolaDiabetes CanadaBoehringer Ingelheim JapanDaiichi Sankyo EuropeBayerGilead SciencesAbbott Diabetes CareKowa CompanySanofiPontificia Universidad JaverianaAbbott JapanBayer YakuhinNovartisAmgenEli Lilly and Company
KeywordsMedicineInsulinIntensive care medicineMEDLINEInternal medicine

Abstract

fetched live from OpenAlex

Injectable insulin therapy is a valuable therapeutic option for millions of people with diabetes worldwide. However, many people with diabetes undergoing insulin therapy experience suboptimal outcomes and/or have complications because of inadequate injection technique and training. Practical, current, evidence-based recommendations are mandatory for primary care practitioners and diabetes specialists alike to address unmet needs in insulin injection technique, education, and consequent outcomes. The most recent global insulin injection technique best practices were published in 2016 by the Forum for Injection Technique and Therapy Expert Recommendations (FITTER). While injection technique efforts in different regions have reflected some developments since 2016, a global effort was warranted to comprehensively capture new evidence and modern expert perspectives. In this article, we share the output of the "FITTER Forward" initiative, authored by 16 diabetes specialists from 13 countries who met virtually in 2023-2024. FITTER Forward provides an updated rationale for the importance of proper injection technique training and its impact on diabetes management. The FITTER Forward recommendations are organized for use in clinical practice and include 4 sections describing (1) the foundational science informing injection device design, experiences, and outcomes, (2) proper injection technique procedures for insulin pens and syringes from insulin storage to needle disposal, (3) lipodystrophy risk reduction, with a focus on lipohypertrophy, and (4) structured injection technique training programs for people with diabetes. Overall, FITTER Forward aims to better equip health care professionals to advance diabetes care by empowering people with diabetes and their caregivers to correctly and safely deliver insulin.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.001
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: none
GenreCandidate signal: Review · Consensus signal: Review
Teacher disagreement score0.920
Threshold uncertainty score0.873

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0010.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.000
Bibliometrics0.0010.001
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.001
Insufficient payload (model declined to judge)0.0000.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.039
GPT teacher head0.419
Teacher spread0.379 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designNot applicable
Domainnot available
GenreReview

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations17
Published2025
Admission routes2
Has abstractyes

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