INS and diabetes mellitus: Their results showed that over 2007 to 2014, the mean HbA1c level as an indicator of glycemic control in patients with diabetes did not change significantly.[27] Considering this result and the increased use of insulin pens in the United States over the similar time period, it can be concluded that despite a shift toward pen devices use among patients with diabetes, there were no improvements in glycemic control in this group of patients.