PurposeThe purpose of the study is to assess whether proper Injection Technique (IT) is associated with improved glucose control over a three month period.MethodsPatients (N = 346) with diabetes from 18 ambulatory centers throughout northern Italy who had been injecting insulin ≥ four years answered a questionnaire about their IT. The nurse then examined the patient's injection sites for the presence of lipohypertrophy (LH), followed by an individualized training session in which sub-optimal IT practices highlighted in the questionnaire were addressed. All patients were taught to rotate sites correctly to avoid LH and were begun on 4 mm pen needles to avoid intramuscular (IM) injections. They were instructed not to reuse needles.ResultsNearly 49% of patients were found to have LH at study entry. After three months, patients had mean reductions in HbA1c of 0.58% (0.50%–0.66%, 95% CI), in fasting blood glucose of 14 mg/dL (10.2–17.8 mg/dL, 95% CI) and in total daily insulin dose of 2.0 IU (1.4–2.5 IU, 95% CI) all with p < 0.05. Follow-up questionnaires showed significant numbers of patients recognized the importance of IT and were performing their injections more correctly. The majority found the 4 mm needle convenient and comfortable.ConclusionsTargeted individualized training in IT, including the switch to a 4 mm needle, is associated with improved glucose control, greater satisfaction with therapy, better and simpler injection practices and possibly lower consumption of insulin after only a three month period.

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The pharmacokinetics of nelfinavir tablets (A) and an oral simplified nelfinavir suspension (B) were studied. Twelve healthy volunteers randomly received either five 250-mg nelfinavir tablets or a simplified oral suspension obtained from tablets dissolved in water (nelfinavir 1250 mg in 100 mL of water) in a single dose before being crossed over to the second treatment after a one-week washout period. Blood samples were drawn up to 24 h after drug administration. Nelfinavir concentrations in plasma were analyzed by a specific and validated reverse-phase high-performance liquid chromatography assay (HPLC) with UV detection, and pharmacokinetic values were determined. For the AUC(0-infinity) with means+/-SD of 31.71+/-7.85, 30.88+/-10.28 (microg/L) respectively for treatments B and A, the ratio (F(B/A)) was of 1.1 with a C.I. of 0.90-1.24. For Cmax with means+/-SD of 3.1+/-0.6 (treatment B) and 3.2+/-0.8 mg/mL (treatment A), the ratio was 1.0. with C.I. of 0.92-1.08. The two treatments evidenced no significant differences in AUC(0-inifnity) and Cmax values and the two-one sided t-test showed that the two preparations are bioequivalent. There was no significant difference in Tmax between the liquid and tablets. Nelfinavir suspension might be a option for treating HIV-infected patients with swallowing disturbances or compliance problems.