Does one-to-one demonstration with insulin pads by health-care providers improves the insulin administration techniques among diabetic patients of a Tertiary Care Teaching Hospital in South India?

Effects of an actual insulin injection demonstration on insulin acceptance among patients with T2DM: a pragmatic randomized controlled trial

Introduction. Insulin injection refusal is a challenge when initiating insulin therapy. This study aimed to investigate the effects of an actual insulin injection demonstration on insulin acceptance in patients with type 2 diabetes mellitus (T2DM).

Methods. A pragmatic randomised controlled trial (RCT) was conducted. The participants were patients with T2DM aged 18–65 years old. The control group (CG) received an educational programme regarding T2DM. The intervention group (IG) received the educational programme and actual insulin injection demonstration (a physician-led sample insulin injection using an insulin pen). The main outcome was immediate insulin acceptance. Insulin adherence, glycated haemoglobin (HbA1c), and adverse effects of insulin were evaluated at three months after the intervention.

Results. Forty-nine participants with T2DM were allocated to the IG (n = 24) and the CG (n = 25). The immediate insulin acceptance was significantly higher in the IG (79.17%, n = 19) than the CG (24.00%, n = 6; p < 0.05; RR 3.30, 95% CI 1.59 to 6.82). At the three-month follow-up, the insulin adherence was significantly different between the two groups (IG: 75.00%, n = 18 vs CG: 20.00%, n = 5; p < 0.05; RR 3.75, 95% CI 1.66 to 8.49). Adverse effects of insulin, HbA1c levels, and changes in HbA1c levels between the IG and CG were not different.

Conclusion. The physician-led actual insulin injection demonstration is effective for increasing insulin acceptance among participants with T2DM.

Assessment of Insulin Injection Technique Among Diabetic Patients in Makkah Region in Saudi Arabia

INTRODUCTION

Diabetes mellitus (DM) is defined as a chronic metabolic disorder characterized by persistent high blood glucose. Proper insulin injection is indispensable to achieve adequate control of DM and prevent complications. Therefore, this study aims to assess the knowledge of DM patients about their insulin injection techniques.

MATERIALS AND METHODS

A questionnaire-based and cross-sectional study was carried out from January to March 2020 at three locations in Makkah, Saudi Arabia. The inclusion criteria of research subjects included patients diagnosed with type-1 or type-2 DM and using insulin pen injection. The questionnaire included demographic data including age, gender, nationality, educational level, and chronic disease as well as specific questions about insulin injection technique.

RESULTS

Four hundred and thirty-seven DM patients participated in the study. The most prevalent age group was between 20 and 60 years old (69.1%). The vast majority of patients were females (64.1%), Saudi nationals (92.9%), and residents of Makkah city (70%). There were roughly equal numbers of patients with type-1 and type-2 DM (47% and 53%, respectively). With regard to complications of DM, 19.5% of patients had previous acidosis, and 16.5% of patients were admitted to hospital for various complications. Injection-related complications were reported by almost half of the patients (49.9). The knowledge of insulin injection practices was examined among DM patients according to different variables. Only the frequency of administration exhibited a significant difference in the practices toward proper insulin injection technique (p = 0.049); patients who administered insulin injection three times daily had the best practices toward insulin injection when compared to other patients.

CONCLUSIONS

Our study showed that the practices toward insulin use among the surveyed DM patients in Makkah region were not satisfactory. Poor insulin injection technique is an important modifiable risk factor for uncontrolled blood glucose levels. More awareness campaigns and better counseling initiatives are crucial to guarantee steady insulin levels among DM patients.

Knowledge and Attitude on Insulin Self-Administration among Type 1 Diabetic Patients at Metu Karl Referral Hospital, Ethiopia

BACKGROUND

Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. It is a public health problem as the disease is epidemic in both developed and developing counties. Knowledge and attitude of patients regarding insulin self-administration could lead to better management of diabetes and eventually a good quality of life. Despite this, the evidence that showed the knowledge and attitude on insulin self-administration is a substantial deficiency in Ethiopia.

OBJECTIVE

To assess the level of knowledge, attitude, and associated factors on insulin self-administration among type 1 diabetic patients at Metu Karl Referral Hospital, Ethiopia, in 2019.

METHODS

An institutional-based cross-sectional study was conducted among systematically selected 245 type 1 diabetic patients at Metu Karl Referral Hospital, Ethiopia, in January 2019. The data were collected through a face-to-face interview. The collected data were entered using EpiData version 4.2.0.0, cleaned, and analyzed using SPSS version 20. A binary logistic regression model was used. Independent variables with a P value of less than 0.05 in the multivariable logistic regression model were considered significant.

RESULTS

Out of 242 type 1 diabetic patients interviewed, 93 (38.4%, 95% CI (32.3%-44.5%)) had good knowledge and 50 (20.7%, 95% CI (15.6%-25.8%)) had favorable attitude on insulin self-administration. The study also found that being unmarried (AOR = 3.59, 95% CI (1.15-11.3), P = 0.028), increased educational level (AOR = 3.02, 95% CI (1.36-6.74), P = 0.007), and more years of treatment (AOR = 3.70, 95% CI (1.16-11.8), P = 0.027) were factors associated with good knowledge on insulin self-administration, whereas being a member of DM association (AOR = 3.57, 95% CI (1.66-7.69), P = 0.001) was the only factor associated with favorable attitude on insulin self-administration.

CONCLUSION

The knowledge and attitude on insulin self-administration among type 1 diabetic patients were substantially low. Diabetes and insulin self-administration education should be imparted by health professionals at each follow-up visit. Besides, strengthening of information, education, and communication (IEC) on the issue of diabetes and insulin self-administration using mass media (television/radio) plays paramount importance.

Forum for Injection Technique and Therapy Expert Recommendations, India: The Indian Recommendations for Best Practice in Insulin Injection Technique, 2017

Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD.