Teaching better insulin injection technique to diabetes patients can improve blood glucose control, according to Italian researchers.
They said most consultation with insulin-injecting patients involved discussions about glucose control and dose adjustment, and claimed very little time was spent on improving injection technique.
Their study, therefore, focused on injection technique training and needle length shortening to see if these could have an impact on diabetes management.
“The implications of our study are striking”
In the study, 346 patients who had been injecting insulin for a minimum of four years answered a questionnaire about their injection technique.
A nurse then examined the patient’s injection sites for the presence of lipohypertrophy, followed by an individualised training session in which any sub-optimal injection technique practices highlighted in the questionnaire were addressed.
All patients were taught to rotate sites correctly to avoid lipohypertrophy and were begun on 4mm pen needles to avoid intramuscular injections. They were instructed not to reuse needles.
Patients were evaluated after the first three months in order to assess their injection technique, changes in clinical parameters and the state of their injection sites.
At the start of the study, the researchers found most patients used the four conventional injection sites – abdomen, thighs, upper arm and buttocks – although the buttock was used less frequently.
However, a number of patients were found to be injecting in other sites, including the elbow and the forearm. In addition, nurses found lipohypertrophy in 48.7% of patients.
The researchers found that injection technique education not only improved blood glucose control, but also provided greater satisfaction with therapy and lowered the daily consumption of insulin after three months.
By the end of the study, the researchers said the majority of patients showed an improved understanding of injecting devices, the care and maintenance of injection sites, the means of avoiding complications such as lipohypertrophy and the necessity of rotating injection sites.
Specifically, most patients had abandoned the pinch-up technique. There was also a significant shift in favour of longer “in-dwell” times, with more patients leaving the needle under the skin for a full 10 seconds after depressing the plunger.
Overall, patients had mean reductions in HbA1c of 0.58% in fasting blood glucose of 3.5mmol/L and in total daily insulin dose of 2.0 IU.
However, lipohypertrophy rates were unchanged at three months, said the study authors.
Nevertheless, they described the implications of their research as “striking”.
“Patients and professionals do not have to wait for months and years to see improvement in the most important clinical parameters – blood glucose control and insulin reduction – when appropriate injection training and devices are provided,” they said in the Journal of Clinical and Translational Endocrinology.
“These improvements can be expected early enough in the course of insulin therapy to enhance patient motivation towards continuous improvement,” they added.