Insulin Injection Technique Questionnaire: results of an international study comparing Brazil, Latin America and World data

Abstract

BackgroundIn 2014–2015, the largest international survey of insulin injection technique in patients with diabetes taking insulin was conducted in 42 countries, totaling 13,289 participants. In Brazil, patients from five public health centers were included. This study aims to evaluate insulin injection technique in Brazilian patients and compare results with Latin America (LatAm) and World data.MethodsThe insulin Injection Technique Questionnaire (ITQ) survey consisted of an initial patient section (questions applied by an experienced nurse), followed by observation of injection technique and examination of the injection sites by the health care professional.ResultsIn Brazil, 255 patients were evaluated: 25% had type 1 diabetes mellitus (T1DM) and 75% had T2DM. In this study, 79% of patients injected less than 4 times a day, and 17.3% used insulin pens, compared to 28% in LatAm and 86% worldwide. Syringes were used by 78% of patients in Brazil, compared to 65% in LatAm and 10% globally. Differences in needle length were substantial—nearly 64% in Brazil inject with 8 mm length needle compared to 48% in LatAm and 27% worldwide. Additionally, 48% of patients in Brazil skip doses, 80% reuse pen needles and 57% reuse syringes with 27% having lipohypertrophy by exam.ConclusionBrazilian patients use syringes more and pens less, inject with larger needles and have more lipohypertrophy when compared to Latin America and World data. Their re-use of needles and syringes is also high. This study showed that in Brazil, teaching of proper injection technique has to be more widespread, and more intensive during diabetes educational sessions, and the type of delivered supplies must be updated to smaller, shorter needles preferred by patients, in order to facilitate adherence to treatment. From the ITQ, we conclude that there are many aspects of insulin injection technique that may be improved in Brazil.

Therapeutic play to teach children with type 1 diabetes insulin self‐injection: A pilot trial in a developing country

“…Further, the most common errors in injection technique were observed for youth using insulin vial and syringe. Injections with a pen comprise fewer steps than injections with a syringe and vial; however, access to insulin pens can be challenging in under‐resourced countries like Brazil, reinforcing the need to engage the child and family in the proper use of vials and syringes, potentially through play‐based interventions (Calliari et al, 2018). Furthermore, literature has shown that children engage better in self‐care when real medical equipment is used in the education process (Koller, 2018), what might explain why children who participated in the ITP intervention had higher injection technique scores than children who received standard education.…”

The use of insulin in treatment for inpatients with diabetes in Can Tho, Vietnam 2017 to 2020

“…Mean (± SD) insulin dose was 23.4 ± 10.6 UI/day. Studies in China, India, Poland, Brazil, and 42 countries noted that mean of insulin values are different (Frid et al, 2016;Calliari et al, 2018;Kalra et al, 2018;Song et al, 2018;Gorska-Ciebiada et al, 2020) possibly because the mean of Asians' BMI is lower than that of the world's (McHugh et al, 2011).…”

Insulin injection technique in Western region of Algeria, Tlemcen

“…Almost all Algerian patients inject insulin using pens (98%), in line with the global international movement to transition from using syringes to using pens. Slight differences with international results may be explained by the fact that syringes continue to be the preference in some countries, such as Brazil [ 7 ] and India [ 9 ], and by the relatively recent introduction of insulin pumps in Algeria. The use of these devices is still limited to specific departments of the largest Algerian hospitals and are not reimbursed, as well as their consumables [ 23 ].…”

“…In conjunction, detailed results country-by-country were populated into an interactive format [ 6 ]. During the past three years, many countries have published their national data [ 7 - 13 ]. The number of countries participating in the international studies on insulin injection technique has steadily increased [ 3 , 14 - 16 ] although Algeria has never been one of them.…”