{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T22:35:46Z","timestamp":1788042946121,"version":"build-2784847793"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T00:00:00Z","timestamp":1614902400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>We used data from two public health surveillance systems for national estimates and detailed descriptions of insulin mix\u2010up errors resulting in emergency department (ED) visits and other serious adverse events to help inform prevention efforts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>ED visits involving patients seeking care for insulin medication errors collected by the NEISS\u2010CADES project in 2012\u20132017 and voluntary reports of serious insulin medication errors submitted to the US Food and Drug Administration (FDA) in 2016\u20132017 were analyzed. National estimates of insulin product prescriptions dispensed from retail pharmacies were obtained from IQVIA National Prescription Audit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2012 and 2017, based on 514 NEISS\u2010CADES cases, there were an estimated 5636 (95% CI, 4143\u20107128) ED visits annually for insulin mix\u2010up errors; overall, over three\u2010quarters (77.5%; 95% CI, 71.6%\u201383.3%) involved taking rapid\u2010acting instead of long\u2010acting insulin. Between 2012 and 2017, the proportion of mix\u2010up errors among all estimated ED visits for all insulin errors decreased by 60%; concurrently, the proportion of pens among all insulin package types dispensed increased by 50%. Among 58 voluntary reports submitted to FAERS, over one\u2010half (56.9%) of cases involved taking rapid\u2010 instead of long\u2010acting insulin. Among 27 cases with documented contributing factors, approximately one\u2010half involved patients having difficulty differentiating products.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among all ED visits for insulin errors collected by NEISS\u2010CADES in 2012\u20132017, the proportion involving mix\u2010up errors has declined. Continued reductions may require additional prevention strategies, including improving insulin distinctiveness, particularly for rapid\u2010 vs long\u2010acting insulins. Ongoing national surveillance is important for identifying the impact of interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5212","type":"journal-article","created":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T14:15:56Z","timestamp":1614176156000},"page":"573-581","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Outpatient insulin\u2010related adverse events due to mix\u2010up errors: Findings from two national surveillance systems, United States, 2012\u20132017"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2502-0289","authenticated-orcid":false,"given":"Andrew I.","family":"Geller","sequence":"first","affiliation":[{"name":"Division of Healthcare Quality Promotion Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariane O.","family":"Conrad","sequence":"additional","affiliation":[{"name":"Division of Medication Error Prevention and Analysis, Office of Medication Error Prevention and Risk Management, Office of Surveillance and Epidemiology Center for Drug Evaluation and Research, Food and Drug Administration  Silver Spring Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina J.","family":"Weidle","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion Centers for Disease Control and Prevention  Atlanta Georgia USA"},{"name":"Eagle Contracting LLC (contractor to Centers for Disease Control and Prevention)  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hina","family":"Mehta","sequence":"additional","affiliation":[{"name":"Division of Medication Error Prevention and Analysis, Office of Medication Error Prevention and Risk Management, Office of Surveillance and Epidemiology Center for Drug Evaluation and Research, Food and Drug Administration  Silver Spring Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Budnitz","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8700-8539","authenticated-orcid":false,"given":"Nadine","family":"Shehab","sequence":"additional","affiliation":[{"name":"Division of Healthcare Quality Promotion Centers for Disease Control and Prevention  Atlanta Georgia USA"},{"name":"Lantana Consulting Group (contractor to Centers for Disease Control and Prevention)  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,5]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"American Association of Diabetes Educators.Teaching injection technique to people with diabetes2017;https:\/\/www.diabeteseducator.org\/docs\/default-source\/practice\/practice-documents\/practice-papers\/teaching-injection-technique-to-people-with-diabetes.pdf?sfvrsn=0. 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