Worldwide Injection Technique Questionnaire Study

Abstract

From February 1, 2014, through June 30, 2015, 13,289 insulin-injecting patients from 423 centers in 42 countries participated in one of the largest surveys ever performed in diabetes. The first results of this survey are published elsewhere in this issue. Herein we report that the most common complication of injecting insulin is lipohypertrophy (LH), which was self-reported by 29.0% of patients and found by physical examination in 30.8% by health care professionals (HCPs). Patients with LH consumed a mean of 10.1 IU more insulin daily than patients without LH. Glycated hemoglobin levels averaged 0.55% higher in patients with vs without LH. Lipohypertrophy was associated with higher rates of unexplained hypoglycemia and glycemic variability as well as more frequent diabetic ketoacidosis, incorrect rotation of injection sites, use of smaller injection zones, longer duration of insulin use, and reuse of pen needles (each P<.05). Routine inspection of injection sites by the HCP was associated with lower glycated hemoglobin levels, less LH, and more correct injection site rotation. Patients were also more likely to rotate correctly if they received injection instructions from their HCP in the past 6 months. Fewer than 40% of patients claimed to have gotten such instructions in the past 6 months, and 10% said that they have never received training on how to inject correctly despite injecting for a mean of nearly 9 years. Use of these data should stimulate renewed commitment to optimizing insulin injection practices.

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

“…Most participating nurses were not trained to properly examine for LH. Given this caveat, the reported presence of LH in pediatric patients injecting insulin seems to be even higher than that in their adult counterparts [4], being roughly 41–47% across the three age groups. The high percentage of LH in G1 is striking, given that these children had only used insulin for a mean of 2.0 (SD 0.82) years.…”

“…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]. This international effort was followed by national recommendations in many countries, including India [29].…”

“…From February 2014 until June 2015 we administered the Insulin Injection Technique Questionnaire (ITQ) to 13,289 patients from 425 centers in 42 countries [3, 4]. Of these patients, 898 (6.8%) were in the pediatric age range (≤ 18 years).…”

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

“…Rotation appeared to be a major problem in other cohorts from previously described studies as well. [34353637]…”

“…[313237] Another study from Spain enrolling both T1DM and T2DM patients with 90% pen device users reported LH in 2/3 rd . [7] The following confounders may be responsible for lower prevalence of LH in our study: (i) ours was not a prospective study (ii) mean duration of insulin treatment and mean number of injection per day were comparatively lower in our cohort.…”