Forum for Injection Technique (FIT), India: The Indian recommendations 2.0, for best practice in Insulin Injection Technique, 2015

Tandon, Nikhil; Kalra, Sanjay; Balhara, Yatan Pal Singh; Baruah, Manash P; Chadha, Manoj; Chandalia, Hemraj; Chowdhury, Subhankar; Kesavadev, Jothydev; Kumar, Prasanna K. M.; Madhu, SV; Mithal, Ambrish; Modi, Sonal; Pitale, Shailesh; Sahay, Rakesh; Shukla, Ram Mohan; Sundaram, Arunkumar; Unnikrishnan, Ambika Gopalakrishnan; Wangnoo, Subhash Kumar

doi:10.4103/2230-8210.152762

Cited by 67 publications

(86 citation statements)

References 38 publications

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“…Sustained and concerted efforts, carried out over the past two decades, have ensured that injection technique is now recognized worldwide as an important aspect of insulin therapy. The FIT (Forum for Injection Technique) recommendations released in 2009 and national guidelines from the UK, Ireland, China, Canada, Switzerland, India, and South Africa are evidence of this welcome development [27, 28]. Newer evidence based on the ITQ [3, 4] led to the publication of the New Insulin Delivery Recommendations in 2016 [5].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

et al. 2018

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IntroductionThe 2015 Insulin Injection Technique Questionnaire survey involving 13,289 patients included 898 (6.8%) patients in the pediatric age range (≤ 18 years).MethodsThe younger patients included in the questionnaire survey were grouped according to age: Group 1 (G1), 0–6 years, n = 85; Group 2(G2), 7–13, n = 423; Group 3 (G3), 14–18, n = 390. The injection technique was evaluated by means of a questionnaire and nurse assessment.ResultsNurses found lipohypertrophy at injection sites in 41.3, 45.2, and 47.3% of patients in G1, G2, and G3, respectively. Unexpected hypoglycemia was common, ranging from 23.8 to 48.1% of patients, and glucose variability was even more common (61.0% in G1, 45.9% in G2, and 52.5% in G3); both conditions were associated with lipohypertrophy. While increasing numbers of patients were using the recommended 4-mm needles, large percentages still used longer ones (33.3% in G1, 45.9% in G2, and 61.5% in G3). The reuse of needles was also common, ranging from 21.1 to 32.5% in the three age groups. Excessive reuse, defined as using a single needle more than five times, was reported by 9.4–21.8% of patients in the three age group. The percentages of patients who had not received any injection training in the last 12 months ranged from 21.2 to 26.8% in the three groups.ConclusionImplications of our study are as follows: (1) pediatric patients should use 4-mm pen needles or 6-mm syringes (inserted at a 45° angle); (2) patients aged ≤ 6 years should always inject into a raised skin fold regardless of which device is used; (3) all patients should rotate sites and use needles only once to avoid lipohypertrophy.FundingBecton–Dickinson (BD) diabetes care.

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Section: Discussionmentioning

confidence: 99%

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

et al. 2018

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“…Addenda were published in the November 2013 and November 2014 issues of that journal. The latest version of these recommendations were published in 2015 [43]. That version provides the following guidelines for preventing LH:

Regular inspection and palpation of insulin sites

Do not reuse needles

Follow correct site rotation policy

Use larger injection surface areas

Do not inject into LH sites

Reduce dose of insulin in habitual LH site injections when shifting to normal SC tissue

Rule out LH as a cause of poor glycemic control, hypoglycemia, and high glycemic variability

…”

Section: Resultsmentioning

confidence: 99%

Indian Injection Technique Study: Injecting Complications, Education, and the Health Care Professional

Kalra

Mithal²,

Sahay

et al. 2017

Diabetes Ther

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IntroductionUsing the Indian and rest of world (ROW) injection technique questionnaire (ITQ) data, we address key insulin injection complications.MethodsIn 2015 we conducted an ITQ survey throughout India involving 1011 patients. Indian values were compared with those from 41 other countries participating in the ITQ, known here as ROW.ResultsMore than a quarter of Indian insulin users described lesions consistent with lipohypertrophy (LH) at their injection sites and approximately 1 in 5 were found to have LH by the examining nurse (using visual inspection and palpation). Just over half of Indian injectors report having pain on injection. Of these, 4 out of 5 report having painful injections only several times a month or year (i.e., not with every injection). Doctors and diabetes educators in India (as opposed to nurses) have a larger role in teaching patients how to inject than they do in ROW. Despite this specialized approach, a very high percentage of patients report that they have not been trained (at least cannot remember being trained) in a wide range of essential injection topics. Only about 30% of Indian injectors get their sites checked at least annually, with nearly a third only having sites checked when they specifically complained and nearly 4 out of 10 never having had their sites checked.ConclusionIndian HCPs can clearly do a better job covering all the vital topics essential to proper injection habits.

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“…LH is a thick soft to firm swelling with “rubbery” consistency, and LA is a scarring lesion with depression. [3456] There was a strong relationship between the presence of LH and improper or lack of rotation of sites, as found in studies encompassing a detail analysis of execution of insulin injection process and their implications. [7] LH retards insulin absorption significantly and to a sufficient magnitude to have an adverse effect on diabetes control.…”

Section: Introductionmentioning

confidence: 99%

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

Baruah

Kalra

Bose

et al. 2017

Indian J Endocr Metab

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Introduction:Insulin remains the cornerstone of therapy in a substantial number of patients with type 2 diabetes mellitus (T2DM). Inadequate knowledge regarding insulin usage is likely to influence its acceptance and adherence, and outcome of therapy, underscoring great need to investigate knowledge, attitude, and practice of insulin usage in patients with T2DM.Methodology:A cross-sectional registry-based retrospective study analyzed data collected from 748 respondents (male: 466, female: 282), mostly from high or middle economic status, who were enrolled as outpatient in a referral clinic during last 10 years (2006–2016), to assess the general characteristics of patients with type 2 diabetes and their baseline knowledge, attitude, and practice of insulin usage and injection practices.Results:Mean ± standard deviation (SD) of duration of diabetes was 12.24 ± 7.60 years and mean ± SD duration of insulin therapy was 3.42 ± 4.18 years, which was initiated after a mean ± SD diabetes duration of 8.80 ± 6.42 years. Mean insulin dose per kilogram of body weight/day was 0.51 ± 0.27 units. Total daily dose of insulin was 33.36 ± 18.44 units and number of injections/day (mean ± SD) was 2.06 ± 0.73. Among the respondents, 58.96% were on human insulin and 35.70% were on analog insulin. Pen devices were used by 66.08% of the population whereas 31.76% used insulin syringes. The prevalence of lipohypertrophy (LH) was 12.57%, which was significantly (P < 0.001) associated with wrong technique with regard to injection angle (10.45% vs. 23.02%), site of injection (7.00% vs. 30.51%), rotation of site of injection (0.88% vs. 17.66%), and reuse of needle (5.77% vs. 15.19%). LH was also significantly (P < 0.05) associated with the use of human (14.74%) compared to analog insulin (8.24%).Conclusion:The current study highlights the unique patterns of insulin usage and associated high prevalence of LH among insulin users in India.

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Forum for Injection Technique (FIT), India: The Indian recommendations 2.0, for best practice in Insulin Injection Technique, 2015

Cited by 67 publications

References 38 publications

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

Indian Injection Technique Study: Injecting Complications, Education, and the Health Care Professional

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

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