Does one-to-one demonstration with insulin pads by health-care providers improves the insulin administration techniques among diabetic patients of a Tertiary Care Teaching Hospital in South India?

Abstract

Objectives:The study was aimed to capture the effect of using injection pads as a tool in educating the diabetic patients who were on insulin. The attitude and practice of the patients in storage of insulin vials and disposal of insulin syringes were also assessed.Materials and Methods:A facility based Quasi-experimental study was carried out among the diabetic patients on insulin, attending diabetic clinic in endocrinology OPD in a tertiary care hospital, Puducherry. One to one intervention was given to the study participants or their attendants (who were involved in injecting insulin), by a trained investigator regarding all the steps of insulin administration. The insulin administration practices before and immediately after the intervention was assessed using a checklist.Results:In total 91 patients were included for the study with mean (SD) age of 53.9 (10.6) years and of them 76% were females. The attitude and practices of the study participants, such as hand washing before handling insulin, checking the expiry date, storage of insulin, inspection of injection site, rolling and cleaning the vial, withdrawal of the syringe up to the required dose, pushing the plunger after inserting the syringe into the vial, checking and removal of air bubbles, cleaning the injection site and allow to dry and injection technique improved significantly after the intervention (P < 0.05).Conclusion:This study findings shows that using injection pads for educating patients helps them to practise better insulin administration. The findings from the study can be applied in routine care and has to be explored further in diabetic patient management.

Forum for injection technique and therapy expert recommendations, India: The Indian recommendations for best practice in insulin injection technique, 2017

“…Even among the literate patient groups, inclination to practice insulin self-administration is low. [5] All injectable agents rely on correct injection technique for optimal delivery and effect. [6] Physician awareness and willingness to convey this information, can help promote correct injection technique among PWD and even other HCPs.…”

“…This leads to either glycemic variability or unexplained hypoglycemia and subsequently compromised long-term outcomes. [ 4 5 ]…”

Assessment of Insulin Injection Technique Among Diabetic Patients in Makkah Region in Saudi Arabia

“…Improper insulin injection technique is a common phenomenon. It can lead to glycemic variability and subsequently compromised short- and long-term complications [ 5 , 9 ]. Such aftermaths include injection site-related pain, bruising, allergy, infection, and lipodystrophy [ 10 , 11 ].…”

Practical guidance on insulin injection practice in diabetes self-management in the Indian setting: an expert consensus statement

“…Incorrect selection of injection site or delivery device and inappropriate injection technique are considered to modify insulin absorption parameters, leading to higher amount of insulin use and higher glycated haemoglobin (HbA 1c ) values as well as to glycaemic variability, unexplained hypoglycaemia and poor longterm outcomes [8][9][10]. Therefore, correct insulin injection technique and correct choice of injection site and delivery devices have been considered as important as providing optimal (type and dose) insulin therapy in achievement of glycaemic goal in diabetes [5,11].…”

“…Identification of patient, provider, and healthcare system based barriers of initiating and adhering to insulin injection therapy is a critical step toward successful diabetes self-management [5,[12][13][14][15][16]. Optimal delivery and effect of all injectable agents rely on correct injection technique [17], emphasizing the role of enhanced awareness of the good injection practices among healthcare professionals (HCPs) as well as patients [5,9,18]. Several guidelines on insulin self-administration are available across the world as well as in India, whereas as consistently reported by several studies across the globe, there is a significant gap between the recommendations of the guidelines and actual insulin injection practice [5,8,10,[19][20][21].…”