Improved needle designs could increase patient compliance with insulin therapy. In this issue of Journal of Diabetes Science and Technology, Hirsch and colleagues assessed patient pain and preference for a 5-bevel needle design among diabetes patients. A blinded comparison with traditional 3-bevel needles yielded no significant difference, but patients preferred the 5-bevel needle in unblinded home injection and clinical insertion studies. This suggests that important subjective/contextual factors contribute to preference in conjunction with the fundamental needle design change. While 5-bevel needles may increase patient acceptance, more dramatic changes of needle design, such as microneedles, could enable still greater patient acceptance through reduced pain as well as improved insulin pharmacokinetics.