AMD-OSDI Consensus on Injection Techniques for People with Diabetes Mellitus

Abstract

It goes without saying that all people with diabetes should be taught the best injection technique before starting insulin treatment. Nevertheless the extremely high rate of local injection-related skin reactions-i.e., lipodysthrophic lesions-described in literature, proves otherwise.We are hereby presenting a Consensus Document on Injecting Techniques which highlights 18 key points based on a thorough analysis of the available literature and ranked by "Level of evidence" and "Strength of recommendation" according to our National Guideline System.It is meant at providing all professionals involved in diabetes care with a practical guide on how to help patients on insulin perform well. Keywords: Insulin injections; Diabetes mellitus;Recommendations; Lipohypertrophy Was a Consensus Document on Injecting Techniques really needed?According to data from ISTAT (National Institute of Statistic) 2011 report [1] about 3 million people with diabetes mellitus (DM) are living in Italy nowadays, mostly in the South of our country, with a 5.1% prevalence of type 1 DM (T1DM). ARNO 2011 report, on the other side, witnessed in favour of a 10-year lasting ever increasing utilization of newer insulin preparations endowed with a more physiological pharmacokinetics profile, such as rapid-acting and basal analogues, as well as, of innovative therapeutic regimes [2]. In spite of technological progresses, and a general improvement in the quality of care, the 2012 AMD Annals [3] reported that only 22.2% T1DM and 43.8% T2DM patients reached HbA1c levels below 7% (53 mmol/mol), and T2DM patients above 9% (75 mmol/mol) accounted for 25.7% monitored people.Many factors related to insulin administration, storage and handling might contribute to poor metabolic control. Therefore, a major goal of health care teams is to educate patients and caregivers to the best possible injectable drug administration techniques and the most skilful utilization of related available devices.In order to let them reach that goal, we collected all available scientific evidences on this issue and organised it according to well-defined hierarchically distributed criteria targeted at patient's self-management/empowerment [4], and based on National Guideline System [5] with structured education on top. Our Consensus Document on Injecting Techniques represents in fact the final result of this strong clinical effort. Recommendations concerning injectable drug administrationA correct injection technique is essential for insulin and other subcutaneously administered medications to ensure optimal effects in people with diabetes mellitus (DM). It implies the ability to (i) choose the best needles, (ii) rotate injection sites regularly, (iii) handle and store insulin appropriately, (iv) insert needles correctly into the skin, (v) let pen needles inside the skin long enough to get the whole dose be absorbed and (vi) manipulate the skin before and after injection (Table 1) Insulin must be injected into intact subcutaneous tissue and intramuscular shots have to be av...

Insulin-Related Lipohypertrophy in Hemodialyzed Diabetic People: a Multicenter Observational Study and a Methodological Approach

“…Another factor eventually contributing to HYPO and GV rate and adding to comorbidities typically found in dialyzed patients might be the presence of insulin-related skin lipohypertrophy (LH) [10–15]. Indeed LH has been shown to deteriorate both quality of life [11] and glycemic control [16, 17] despite increased insulin dosage [11], thus raising costs [30] as a result of higher acute/chronic complications and emergency room access rates [12, 18, 19].…”