An audit of insulin usage and insulin injection practices in a large Indian cohort

Baruah, Manash P; Kalra, Sanjay; Bose, Saptarshi; Deka, Jumi

doi:10.4103/ijem.ijem_548_16

Cited by 47 publications

(44 citation statements)

References 33 publications

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“…Thus, it can be hypothesized that rapid-acting insulin analogs with their improved pharmacokinetic actions might spare adipocytes from the lipogenic action as compared to conventional insulins. It is further supported by previous reports which suggest that faster absorption of insulin analogs reduces the stay of insulin in adipocytes and thereby provides a break from the local lipogenic action of insulin ( 33 , 34 ). Findings of present study also showed that as compared to multiple daily injections of rapid plus long-acting analogs, risk of lipohypertrophy further augmented to 4.6 times with conventional premixed insulins (twice daily).…”

Section: Discussionsupporting

confidence: 83%

“…On the other hand, despite the statistically insignificant ( p = 0.067) results, the pioneer European survey involving 1,002 patients accredited needle reuse as a contributor to lipohypertrophy ( 28 ). Furthermore, many subsequent studies unhesitatingly acknowledged the association of lipohypertrophy with needle reuse, only on the basis of univariate analysis ( 12 , 27 , 34 , 46 ). Vardar et al ( 26 ), Blanco et al ( 24 ), Ji et al ( 6 ), and Frid et al ( 25 ) did employ the multivariate analysis in their investigations.…”

Section: Discussionmentioning

confidence: 99%

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Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma?

et al. 2018

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Lipohypertrophy has been suggested as an outcome of lipogenic action of insulin and/or injection-related tissue trauma. In a cross-sectional study, we evaluated the predictors of lipohypertrophy in 372 type 1 diabetes patients (mean age 17.1 years) receiving subcutaneous insulin with pen and/or syringes for ≥3 months. On examining injection sites with inspection and palpation technique, 62.1% patients demonstrated lipohypertrophy. Univariate analysis showed that gender, BMI, HbA1c, injection device, rotation, injection area, needle length, insulin regimen, and total daily dose of insulin were associated with lipohypertrophy (p < 0.05). Notably, the mean needle reuse was comparable in patients with or without lipohypertrophy (8.1 vs. 7.2, p = 0.534). In multivariate logistic regression, gender, HbA1c, TDD, injection devices, and needle length lost its significance. Further, injections over smaller area (≤8.5 × 5.5 cm) and non-rotation of sites were found to be strongest independent predictor of lipohypertrophy (p < 0.0005 for both) with increased odds of 23.2 (95% CI 9.1–59.2) and 6.3 (95% CI 3.4–11.9) times, respectively. Being underweight was also a significant independent predictor (odds ratio [OR] 13.0 [95% CI 2.2–75.2], p = 0.004). Compared to rapid plus long-acting analogs, regular insulin plus long-acting analogs and conventional premixed insulin users had 3.2 (95% CI 1.5–6.8, p = 0.003) and 4.6 (95% CI 1.4–15.7, p = 0.014) fold higher risk of lipohypertrophy (mean injection frequency 4.01 vs. 4.01 vs. 2.09, respectively). Sub-group analysis showed that lipohypertrophy was 79% less likely in patients with multiple daily injections (≥4) than twice-daily regimen (OR 0.21, p < 0.0005). Moreover, lipohypertrophy was reduced to half with bolus doses of rapid-acting insulin analogs than regular insulin (p = 0.003), even though mean injection frequency was comparable (4.01 vs. 3.93, p = 0.229). This difference was statistically insignificant for basal doses with NPH or long-acting analogs (p = 0.069). Therefore, injection area, rotation, BMI, and insulin regimen are the best predictors of lipohypertrophy and together could correctly identify lipohypertrophy status in 84.4% patients with excellent discrimination capability (AUC = 0.906, p < 0.0005). In conclusion, findings of our study suggest that delivering rapidly absorbed insulin analogs over large injection area along with greater split of total daily doses reduce insulin-induced lipogenesis and outplay tissue trauma added through frequent injections and needle reuse.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma?

et al. 2018

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“…For better bio-availability and to achieve glycemic control, correct insulin injecting techniques have to be followed by the patients. 4 The improper insulin injection techniques will also result in local adverse events such as Lipodystrophy which comprises of lipo hypertrophy (LH) and lipoatrophy (LA). These adverse events are caused by chronic reuse of needles and injections at the same site, improper or lack of rotation of sites.…”

mentioning

confidence: 99%

“…These highlight the need to understand the existing knowledge, attitude and practice regarding insulin usage technique among diabetic patients. 4 With this background, the present study was conducted at a tertiary care Basaveshwara hospital in Chitradurga, among diabetes patients on insulin treatment. The aim and objectives of the study were a) to assess the knowledge and insulin injection practices, b) to assess the risk factors of sharps injury among them.…”

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confidence: 99%

Injection practices among the diabetes patients on insulin therapy in Chitradurga

Sindhu

Rashmi

Prashanth

et al. 2020

Int J Community Med Public Health

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Background: Diabetes mellitus has emerged as a global health problem. Insulin is the essential treatment modality for significant number of diabetic patients. Nearly 4 out of 10 patients with T2DM in India are using insulin, either alone or in combination with oral hypoglycemic drugs (OADs). The present study was conducted with the objectives to assess the knowledge and insulin injection practices, risk factors of sharps injury among diabetic patients who are on insulin treatment.Methods: Cross sectional study was conducted at a Basaveshwara hospital, Chitradurga, among diabetic patients on insulin treatment for minimum of past 6 months. Insulin injection technique questionnaire (ITQ) was administered to study participants and proforma was filled by interview technique.Results: 100 patients participated in the study. Syringe and needle device and 6 mm needle are most commonly used devices. 5-10 seconds was the most common duration of time (54%) for which the patients continued to keep the needle inserted in injection site after insulin injection. A 26% patients had lip hypertrophy at injection sites. Among households of the insulin users, a high percentage of children (41%) and house keeper/waste collectors (32%) were at risk of sharps injury. A majority of 55% of the insulin users reported that they didn’t have appropriate disposal containers for the used sharps.Conclusions: A 29% of participants did not practice proper rotation of injection site. Reuse of insulin needles was common practice. Pain/tenderness, lipo-hypertrophy and leakage of insulin after injection were noted at injection site. 10 seconds dwell time was reportedly practiced by only 23%, about half of patients skipped insulin injections and didn’t follow appropriate disposal of used sharps, thereby exposing both family members and waste collectors/handlers to higher risks of sharps injuries.

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“…The use of ultrasound has been shown by some to improve diagnostic sensitivity both in terms of the frequency and the extent of detection [2]. A recent audit from India [3] reported a much lower prevalence at 12.5% of all insulin users although this was a retrospective collection of cases based only on clinical examination and could be an underestimate while another survey [4] on injection technique found that based on a physical examination by nurses, one in five diabetic patients on insulin had LH. Two recent studies [5,6] from India reported that more than 60% of the patients developed LH.…”

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confidence: 99%

The clinical relevance of lipohypertrophy

Madhu

2019

Int J Diabetes Dev Ctries

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An audit of insulin usage and insulin injection practices in a large Indian cohort

Cited by 47 publications

References 33 publications

Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma?

Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma?

Injection practices among the diabetes patients on insulin therapy in Chitradurga

The clinical relevance of lipohypertrophy

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