Insulin pen injection technique survey in patients with type 2 diabetes in mainland China in 2010

Abstract

Objective:

The efficacy of injection therapy in diabetes depends on correct injection technique. To provide patients with guidance in this area and help patients inject themselves correctly, we must understand how they currently inject; therefore, the purpose of this study was to assess the current situation of insulin injection technique in patients with diabetes in mainland China.

Design and methods:

From October 2010 to November 2010, a cross-sectional survey of 380 diabetes patients from 20 centers in mainland China was conducted regarding their daily insulin pen injection practice.

Results:

Overall, 35.26% of patients had lipohypertrophy; 58.68% of patients had bleeding and bruising, and abdominal lipohypertrophy at injection sites. Bleeding and bruising were more frequent. We found a significant relationship between the frequency of a single needle reuse and lipohypertrophy (r = 0.426, P = 0.000). In addition, there was a significant relationship between the frequency of daily insulin injection and lipohypertrophy (r = 0.146, P = 0.004), between rolling the pen while pulling out the needle after injection and lipohypertrophy (χ²= 7.355, P = 0.007). Bleeding and bruising at injection sites were found to be related to HbA1c levels (r = 0.151, P = 0.003).

Limitations:

A few limitations linked with this survey should be noted. Because of the limited budget, the ultrasound was not used to evaluate lipodystrophy and the photographs of lipodystrophy were not taken. On the other hand, specific size of lipodystrophy and the cost of insulin wastage were not evaluated. Furthermore, the population of this survey is limited, and it was only done in general hospitals and not in community hospitals, therefore, a larger study sample is advisable.

Conclusions:

The insulin injection skill of patients with diabetes in mainland China was poor, and the incidence of lipohypertrophy, bleeding, and needle reuse was high. Frequency of daily insulin injection and needle reuse may relate to the incidence of lipohypertrophy and bleeding. The bleeding and bruising at the injection sites may be associated with suboptimal absorption of injected insulin. Improved education in optimal insulin injection technique, including reducing needle reuse and correct rotation of injection sites should be emphasized.

Keywords::

• Diabetes
• Injection
• Insulin
• Lipohypertrophy

Transparency

Declaration of funding

This paper was sponsored by Becton Dickinson Company, Franklin Lakes, NJ, USA.

Declaration of financial/other relationships

J.J. and Q.L. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors sincerely thank the participants, nurses, and the other investigators in the 20 centers in mainland China, and Becton Dickinson Company for their support.