Forum for injection technique and therapy expert recommendations, India: The Indian recommendations for best practice in insulin injection technique, 2017

Tandon, Nikhil; Kalra, Sanjay; Balhara, Yatan Pal Singh; Baruah, Manash P; Chadha, Manoj; Chandalia, Hemraj; Kumar, KM Prasanna; Madhu, SV; Mithal, Ambrish; Sahay, Rakesh; Shukla, Ram Mohan; Sundaram, Arunkumar; Unnikrishnan, Ambika Gopalakrishnan; Saboo, Banshi; Vk, Gupta; Chowdhury, Subhankar; Kesavadev, Jothydev; Wangnoo, Subhash Kumar

doi:10.4103/ijem.ijem_97_17

Cited by 41 publications

(25 citation statements)

References 159 publications

(175 reference statements)

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“…Newer evidence based on the ITQ [3, 4] led to the publication of the New Insulin Delivery Recommendations in 2016 [5]. This international effort was followed by national recommendations in many countries, including India [29]. …”

Section: Discussionmentioning

confidence: 99%

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

et al. 2018

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IntroductionThe 2015 Insulin Injection Technique Questionnaire survey involving 13,289 patients included 898 (6.8%) patients in the pediatric age range (≤ 18 years).MethodsThe younger patients included in the questionnaire survey were grouped according to age: Group 1 (G1), 0–6 years, n = 85; Group 2(G2), 7–13, n = 423; Group 3 (G3), 14–18, n = 390. The injection technique was evaluated by means of a questionnaire and nurse assessment.ResultsNurses found lipohypertrophy at injection sites in 41.3, 45.2, and 47.3% of patients in G1, G2, and G3, respectively. Unexpected hypoglycemia was common, ranging from 23.8 to 48.1% of patients, and glucose variability was even more common (61.0% in G1, 45.9% in G2, and 52.5% in G3); both conditions were associated with lipohypertrophy. While increasing numbers of patients were using the recommended 4-mm needles, large percentages still used longer ones (33.3% in G1, 45.9% in G2, and 61.5% in G3). The reuse of needles was also common, ranging from 21.1 to 32.5% in the three age groups. Excessive reuse, defined as using a single needle more than five times, was reported by 9.4–21.8% of patients in the three age group. The percentages of patients who had not received any injection training in the last 12 months ranged from 21.2 to 26.8% in the three groups.ConclusionImplications of our study are as follows: (1) pediatric patients should use 4-mm pen needles or 6-mm syringes (inserted at a 45° angle); (2) patients aged ≤ 6 years should always inject into a raised skin fold regardless of which device is used; (3) all patients should rotate sites and use needles only once to avoid lipohypertrophy.FundingBecton–Dickinson (BD) diabetes care.

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Section: Discussionmentioning

confidence: 99%

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

et al. 2018

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“…[38] Our check list was based on the Forum for injection technique and therapy expert, India recommendations. [11] After preparing the initial questionnaire we discussed the same with senior nurses for their expert opinion. However, as stated earlier, there is a need to develop instruments which assess the behaviours and practices.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Injection techniques are considered to be very important and guidelines have been developed for proper insulin techniques globally and in various countries including India. [10,11] These guidelines cover multiple aspects, such as counselling, selection of site, size of needle, storage, and addressing potential complications. [10] Furthermore, health education to patients and nurses helps to reduce morbidity and mortality due to diabetes mellitus by improving knowledge of individual, family and community regarding diabetes management and insulin administration.…”

Section: Introductionmentioning

confidence: 99%

A study to assess the effectiveness of a structured teaching programme on knowledge and practice of safe insulin administration among nurses in a tertiary care hospital: A pre-post design

Punjot¹,

Thomas²,

Vinodkumar³

et al. 2019

JNEP

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Background and objective: Diabetes Mellitus (DM) is not only a health issue but also an economic issue in India. Incorrect insulin injection techniques can lead to side effects such as pain, lipohypertrophy, and poor glycemic control. We designed the present study to assess nurses’ knowledge about safe insulin administration and evaluate the role of a planned teaching programme on knowledge and practices of safe insulin injection techniques in a group of nurses in tertiary care hospital.Methods: This is a pre-post design to study the effectiveness of the structured training programme - one hour of didactic lecture followed by demonstration of safe injection practices. Demographic data and knowledge about safe insulin practices were collected at baseline. We conducted two post training assessments–day one and three months after training. The injection practices were assessed using a check-list. We used the random effects linear regression model to identify factors associated with change in scores over these three observations.Results: The mean (SD) scores for insulin knowledge at baseline was 6.81 (2.28). It significantly increased to 16.85 (1.84) immediately after training (p < .001). These scores reduced significantly after three months compared with post-training scores (14.18 [2.14]; p < .001). A significantly higher proportion of nurses had used re-suspension technique for insulin injection after three months (76.3% vs 52.5%, p = .003) and cleaned the injection site with alcohol swab before injection (93.8% vs. 75.0%, p = .001). On an average, knowledge scores changed by -0.15 (95% CI: -0.29, -0.02; p = .03) with each unit increase in age (years). The average score in nurses with a degree was significantly higher compared with those who had a diploma (1.02, 95% CI: 0.28, 1.76; p = .007).Conclusions: The study demonstrated that insulin injection practices improve with adequate guidance and information. However, there is a need to have a regular training programme to sustain the practices. Certain practices such as site rotation and assessing lipo-hypertrophy, and the relation between these two should be emphasized in these sessions.

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“…Insulin self-administration is an indispensable component of diabetes management and the importance of guiding patients towards best injection practice has increasingly been recognized in accordance with growing awareness of the critical role of the correct injection technique in achieving optimal control of diabetes [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Incorrect selection of injection site or delivery device and inappropriate injection technique are considered to modify insulin absorption parameters, leading to higher amount of insulin use and higher glycated haemoglobin (HbA 1c ) values as well as to glycaemic variability, unexplained hypoglycaemia and poor longterm outcomes [8][9][10]. Therefore, correct insulin injection technique and correct choice of injection site and delivery devices have been considered as important as providing optimal (type and dose) insulin therapy in achievement of glycaemic goal in diabetes [5,11].…”

Section: Introductionmentioning

confidence: 99%

Practical guidance on insulin injection practice in diabetes self-management in the Indian setting: an expert consensus statement

Chawla¹,

Shunmugavelu²,

Makkar

et al. 2019

Clinical Diabetology

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This consensus statement aimed to provide a simple and easily implementable practical educational guideline for healthcare professionals (HCPs) and patients regarding insulin injection practice in diabetes selfmanagement in the Indian setting. A group of experts analysed published data from guidelines, clinical trials and real world evidence to reach consensus recommendations on optimal insulin injection practices in terms of a) the injection sites (preparation of site of injection, choosing the injection site, site rotation), b) choice of device and storage of insulins, and c) safety precautions, sharp disposal practice and complications. Findings from Global and Indian arm of 2014-2015 ITQ Study were considered to emphasize a need for improved practice by HCPs covering all the vital topics essential to proper injection habits. The consensus statement provides a simple and easily implementable practical educational guideline for HCPs and patients to optimize insulin injection practices in accordance with recent advances in device manufacturing, newer research findings, and updated international guidelines as well as widespread concerns about neglected safety precautions such as single-patient use of pens and appropriate sharp disposal practices. (Clin

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Forum for injection technique and therapy expert recommendations, India: The Indian recommendations for best practice in insulin injection technique, 2017

Cited by 41 publications

References 159 publications

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications

A study to assess the effectiveness of a structured teaching programme on knowledge and practice of safe insulin administration among nurses in a tertiary care hospital: A pre-post design

Practical guidance on insulin injection practice in diabetes self-management in the Indian setting: an expert consensus statement

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