A pan‐European epidemiologic study of insulin injection technique in patients with diabetes

Abstract

Aim. A large pan‐European epidemiologic survey of insulin injection techniques was performed in order to determine the epidemiologic profile by centre, country and continent of major issues surrounding insulin injection. Methods. European insulin‐injecting, type 1 or 2 diabetes patients, using insulin for at least 6 months via an insulin pen or syringe; 22 sites in seven countries, 1002 patients in total, 51% female, 58% type 1. Results. Nearly 70% of patients inject using a pinch‐up and this practice is associated with improved HbA1c. Thirty per cent of patients reported having lipohypertrophy. Concurrent nurse evaluation found the prevalence to be 27%. Independent risk factors for lipohypertrophy were found to be failure by the patients to check injection sites regularly, failure to rotate sites and longer duration of DM. Less than 50% of patients reported that they were taught about lipohypertrophy. Needles were used 3.3 times on average in Europe, with wide variation by country. Male sex, type 1 diabetics, a high daily number of injections and the use of the 12.7 mm length needle were factors associated with high needle reuse. Needle reuse, even more than once, increased the risk of lipohypertrophy by 31%. Nearly half of patients dispose of their needles directly into the trash after protecting the needle (recapping or clipping). Alarmingly, 22% dispose directly into the trash without protection. Conclusion. There is a considerable way to go in ensuring optimal insulin injection practices. The issues raised by this study must be addressed by focused and intensive HCP efforts. Copyright © 2002 John Wiley & Sons, Ltd.

The injection technique: results of a questionnaire study of diabetic patients in Russia. New international guidelines on the injectiontechnique

“…Впоследствии опрос-ник был валидирован и использован при проведении анкетирования в 1999-2000 гг. в 7 европейских странах [1,23,24].…”

“…Имеются литературные данные, показывающие, что не со всеми пациентами проводятся занятия по технике инъекций, но даже с теми, кто получает подобную информацию от меди-цинских работников, обсуждаются далеко не все важные аспекты правильного выполнения инъекций [24][25][26].…”

AMD-OSDI Consensus on Injection Techniques for People with Diabetes Mellitus

“…However, despite technological advances allowing newer and newer insulin analogue availability, certain absorption/ action affecting factors still remain, such as exercise, counterregulatory hormones, high dosage, incorrectly mixed preparations or even the habit to pull out needles from the skin too early after pen pistons reaching their end stroke positions [29,30]. Another example of how the injection technique may affect insulin pharmacokinetics is given by glargine [31]: Its long acting effect is based on its ability to precipitate within the subcutaneous tissue at pH 7, and cannot be exploited in case of intramuscular injections, which thus cause unexpected hypoglycaemic episodes [30].…”

“…Injection site rotation within large surfaces, needle disposal after each shot and 45° angle pinch technique utilization with needles >6 mm are essential factors to ensure optimal insulin absorption and prevent skin injury [11,15,22,[29][30][31][32][33][34].…”

“…In the transition from a longer needle to a shorter one, there might be differences in insulin absorption, therefore monitoring blood Subcutaneous tissue thickness varies significantly depending on sex, body mass index, age, ethnicity, diabetes type, morphology of the diabetic individual, as well as, on pressure exerted during injection [8,11,14]. The risk of intramuscular injections depends on that all and has been estimated to be 15.3% with 8 mm, 5.7% with 6 mm and 0.4% with 4 mm needles [14,[26][27][28].Injection site rotation within large surfaces, needle disposal after each shot and 45° angle pinch technique utilization with needles >6 mm are essential factors to ensure optimal insulin absorption and prevent skin injury [11,15,22,[29][30][31][32][33][34].With the advent of insulin analogues, absorption varies much less both between and within individuals and is therefore more predictable and easier to handle by the patient [30]. However, despite technological advances allowing newer and newer insulin analogue availability, certain absorption/ action affecting factors still remain, such as exercise, counterregulatory hormones, high dosage, incorrectly mixed preparations or even the habit to pull out needles from the skin too early after pen pistons reaching their end stroke positions [29,30].…”