The injection technique: results of a questionnaire study of diabetic patients in Russia. New international guidelines on the injectiontechnique

Mel'nikova, Olga Georgievna; Георгиевна, Мельникова Ольга; Mayorov, Alexander Yur'evich; Юрьевич, Майоров Александр

doi:10.14341/2072-0351-5486

Cited by 2 publications

(2 citation statements)

References 28 publications

(35 reference statements)

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“…Формирование липодистрофий в местах инъекцийосновное кожное осложнение инсулинотерапии. По разным оценкам, распространенность индуцированных инсулином липодистрофий составляет от 5 до 53% [1][2][3][4][5]. Наличие участков липодистрофий изменяет абсорбцию препаратов инсулина из места введения [6] и способствует ухудшению качества контроля гликемии [4,5,7,8].…”

Section: оригинальное исследованиеunclassified

“…Анализ техники инъекций инсулина больными СД1 и СД2, проведенный в 16 странах мира, выявил типичные ошибки: введение инсулина в одну и ту же область в течение дня (21%), постоянное или эпизодическое введение инсулина в участки липогипертрофии (3% и 26% соответственно) [2]. При анализе ситуации в России оказалось, что 43,5% больных осуществляли инъекции в пределах одной анатомической области, у 41,5% имелись уплотнения в местах инъекций, причем более половины этих больных продолжали выполнять инъекции в измененные участки [1]. Наши данные также указывают на частые нарушения техники введения инсулина, которые допускают больные СД, при этом введение инсулина в места липогипертрофий является одной из наиболее распространенных ошибок.…”

Section: обсуждение основного результата исследованияunclassified

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Insulin-induced lipohypertrophy: clinical and ultrasound characteristics

Климонтов¹,

Lazarev²,

Фазуллина³

et al. 2018

Diabetes mellitus

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Background: Lipohypertrophy is primary dermal complication of insulin therapy. The data on the prevalence of lipohypertrophy in diabetic subjects are inconsistent, that may be due to the lack of sensitivity and subjectivity of palpation as diagnostic technique. Meanwhile, the reliability of lipohypertrophy detection can be increased by ultrasound. Aims: to compare clinical and ultrasound characteristics and to determine the risk factors of insulin-induced lipohypertrophy in diabetic subjects. Materials and methods: We observed 82 patients, including 26 individuals with type 1 diabetes and 56 subjects with type 2 diabetes. Duration of insulin therapy varied from 3 months to 37 years (median 14 years). The sites of insulin injections were assessed by palpation and ultrasound. Visualization protocol included gray-scale densitometry, strain elastography, and 3D Doppler power ultrasound. Scaled evaluation of ultrasound sings was applied. Insulin injection technique was assessed by questionnaire. Serum levels of insulin antibodies were determined by ELISA. Results: Lipohypertrophy was revealed by palpation and ultrasound in 57 and 80 patients (70% and 98%) respectively. Total lipohypertrophy area, acoustic density and total ultrasound score showed weak positive correlations with daily insulin dose (r=0.3, r=0.3 and r=0.35, respectively, all p0.006). Patients receiving insulin analogues had smaller area of abdominal lipohypertrophy than those on human insulin (p=0.03). A positive correlation was found between abdominal lipohypertrophy area and mean postprandial glucose (r=0.35, p=0.001). A rare needle change and injections in lipohypertrophy sites were the most common deviations in insulin injection technique (70 and 47 subjects, 85% and 53% respectively). The levels of insulin antibodies showed no association with lipohypertrophy parameters. Conclusions: Patients with type 1 and type 2 diabetes demonstrate high prevalence of lipohypertrophy in insulin injection sites. Ultrasonography is more sensitive method of diagnostics of lipohypertrophy compared with palpation. Insulin-induced lipohypertrophy is associated with errors in injection technique and higher insulin doses.

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Section: оригинальное исследованиеunclassified

Section: обсуждение основного результата исследованияunclassified

Insulin-induced lipohypertrophy: clinical and ultrasound characteristics

Климонтов¹,

Lazarev²,

Фазуллина³

et al. 2018

Diabetes mellitus

View full text Add to dashboard Cite

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Predictors of success and failure in achieving glycemic control targets in patients with type 2 diabetes on basal insulin: review of the real-world evidence studies

Климонтов

2022

Diabetes mellitus

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Basal insulin (BI) is the main therapeutic option for patients with type 2 diabetes (T2D) who have not reached glycemic targets on oral antidiabetic drugs and/or glucagon-like peptide-1 receptor agonists. The results of epidemiological studies indicate that the majority of patients with T2D do not achieve the targeted parameters of glycemic control on BI in the real-world settings. In this review the results of real-world evidence studies assessing predictors of success or failure of BI therapy in patients with T2D are we summarized. A number of studies have demonstrated that delayed initiation of insulin therapy with a high level of glycated hemoglobin A1c (HbA1c) at the start of the treatment reduces achieving glycemic control targets on BI. Hypoglycemia in the first weeks or months of BI treatment may reduce the adherence and persistence to treatment and likelihood of achieving treatment targets. In real-world evidence studies, glargine 300 U/mL and degludec, the long-acting second-generation insulin analogues, have shown greater potential in reduction of HbA1c levels with a lower risk of hypoglycaemia compared to other BIs. In the DUNE, ATOS, and some others studies, a lack of insulin dose titration in newly initiated BI users and those who needed treatment intensification was demonstrated. Poor treatment adherence and persistence (missed injections, incorrect dose selection, and temporary or permanent discontinuation of insulin therapy), deviations in insulin injection technique, and formation of lipohypertrophy at the injection sites are also common problems that prevent good glycemic control in these patients. Therefore, patient education with a focus on injection technique, dose titration and prevention of hypoglycemia, as well as the use of the second-generation BI analogs, increases the chances for achieving glycemic control targets in patients with T2D who initiate or need to intensify BI therapy.

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The injection technique: results of a questionnaire study of diabetic patients in Russia. New international guidelines on the injectiontechnique

Cited by 2 publications

References 28 publications

Insulin-induced lipohypertrophy: clinical and ultrasound characteristics

Insulin-induced lipohypertrophy: clinical and ultrasound characteristics

Predictors of success and failure in achieving glycemic control targets in patients with type 2 diabetes on basal insulin: review of the real-world evidence studies

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