Safety of the reuse of needles for subcutaneous insulin injection: A systematic review and meta-analysis

Zabaleta‐del‐Olmo, Edurne; Vlacho, Bogdan; Jódar-Fernández, Lina; Urpí-Fernández, Ana-María; Lumillo-Gutiérrez, Iris; Agudo-Ugena, Josep; Morros-Pedrós, Rosa; Violán, Concepción

doi:10.1016/j.ijnurstu.2016.04.010

Cited by 35 publications

(20 citation statements)

References 37 publications

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“…While Vardar et al ( 26 ) found that lipohypertrophy was associated with needle use more than once; the last three showed its association with lipohypertrophy at the needle reuse frequencies of 5, 7, and 10 times, respectively ( 6 , 24 , 25 ). Also, a meta-analysis performed by Zabaleta-Del-Olmo et al demonstrated that in view of heterogeneity among existing scientific evidences, strong recommendation cannot be made regarding the needle reuse and presence of lipohypertrophy ( 47 ). Thus, the importance of needle reuse in development of lipohypertrophy has to be viewed with recurring extra expenses and time to comply with.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma?

et al. 2018

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“…Although local infections or abscesses have not been documented with needle reuse, FITTER recommendations advise against reusing needles ( 7 ), which are labeled by regulatory agencies for single use. A meta-analysis of 25 studies could not give a conclusion regarding whether needle reuse was acceptable ( 71 ).…”

Section: Needle Reusementioning

confidence: 99%

The Injection Technique Factor: What You Don’t Know or Teach Can Make a Difference

Hirsch

Strauss²

2019

Clinical Diabetes

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IN BRIEF To be consistently effective, insulin must be delivered into subcutaneous tissue. If insulin is delivered intramuscularly, its uptake and action become variably faster, leading to suboptimal, inconsistent glucose control. The best strategy to avoid intramuscular injection is to use the shortest needles available. Injection sites should be rotated systematically to prevent lipohypertrophy, which also substantially affects insulin uptake and action. New evidence-based insulin delivery recommendations are available, and awareness of them should lead to more effective use of insulin therapy, improved clinical outcomes, and considerable cost savings.

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“…Despite manufacturer guidelines that recommend single-use of needles and syringes for insulin injection,12 studies on needle reuse among diabetics show that it is a common practice, as patients find it more affordable and practical 3. A recent systematic review found no conclusive evidence to establish a causal between needle reuse and skin infection; there is little consensus among experts about whether it is safe to reuse needles or not 4. American Diabetes Association guidelines suggest that reusing needles is cost-effective and practical for patients, and that it may be acceptable as long as the needle is not visibly dull or deformed.…”

Section: Discussionmentioning

confidence: 99%

“…Primary cutaneous mucormycosis (PCM) is the clinical presentation of infection at sites of trauma that disrupt the skin barrier 2. Insulin needle reuse is a common practice among diabetic patients,3 and while it has not been proven to be associated with an increased risk of infection in the general diabetic population,4 few case reports of infection at the site of repeated insulin injections in both immunocompetent and immunocompromised patients exist 5–8. We present a case of PCM in a diabetic individual at the site of insulin injection in the context of insulin needle reuse.…”

Section: Introductionmentioning

confidence: 99%

Primary cutaneous mucormycosis of the abdomen at the site of repeated insulin injections

et al. 2020

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A 71-year-old woman with metastatic squamous cell carcinoma of the lung and insulin-dependent type 2 diabetes mellitus presented with a necrotic lesion on her lower abdomen. Further history revealed that this was the site of repeat insulin injections with reuse of the same needles. On investigation, biopsy of the site was positive for broad, aseptate, right-angle branching fungal hyphae consistent with mucormycosis. Studies have shown that insulin needle reuse is a common practice among diabetics for several reasons, including cost and convenience. While the current American Diabetes Association guidelines suggest that this is an acceptable practice among the general population of diabetics, they advise against it in patients who are actively ill or immunocompromised. Discussion about insulin needle reuse should be of utmost importance among providers and their diabetic patients, especially for patients who are immunocompromised.

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Safety of the reuse of needles for subcutaneous insulin injection: A systematic review and meta-analysis

Cited by 35 publications

References 37 publications

Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma?

Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma?

The Injection Technique Factor: What You Don’t Know or Teach Can Make a Difference

Primary cutaneous mucormycosis of the abdomen at the site of repeated insulin injections

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