Worldwide Injection Technique Questionnaire Study

Abstract

From February 1, 2014, through June 30, 2015, 13,289 insulin-injecting patients from 423 centers in 42 countries took part in one of the largest surveys ever performed in diabetes. The goal was to assess patient characteristics, as well as historical and practical aspects of their injection technique. Results show that 4- and 8-mm needle lengths are each used by nearly 30% of patients and 5- and 6-mm needles each by approximately 20%. Higher consumption of insulin (as measured by total daily dose) is associated with having lipohypertrophy (LH), injecting into LH, leakage from the injection site, and failing to reconstitute cloudy insulin. Glycated hemoglobin values are, on average, 0.5% higher in patients with LH and are significantly higher with incorrect rotation of sites and with needle reuse. Glycated hemoglobin values are lower in patients who distribute their injections over larger injection areas and whose sites are inspected routinely. The frequencies of unexpected hypoglycemia and glucose variability are significantly higher in those with LH, those injecting into LH, those who incorrectly rotate sites, and those who reuse needles. Needles associated with diabetes treatment are the most commonly used medical sharps in the world. However, correct disposal of sharps after use is critically suboptimal. Many used sharps end up in public trash and constitute a major accidental needlestick risk. Use of these data should stimulate renewed interest in and commitment to optimizing injection practices in patients with diabetes.

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

“…IM injections are a major risk factor for hypoglycemic events, including the unexpected sort which can lead to accidents, third-party interventions, hospitalization, and possible long-term morbidity [15]. These rates of 4-mm needle usage should also be put into context and compared to the overall findings in the ITQ, where roughly 29% of all patients (93% adult) were described by nurses as using the 4-mm needle, a percentage that is much lower than that reported in pediatric patients [3]. …”

“…The FIT (Forum for Injection Technique) recommendations released in 2009 and national guidelines from the UK, Ireland, China, Canada, Switzerland, India, and South Africa are evidence of this welcome development [27, 28]. 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].…”

“…From February 2014 until June 2015 we administered the Insulin Injection Technique Questionnaire (ITQ) to 13,289 patients from 425 centers in 42 countries [3, 4]. Of these patients, 898 (6.8%) were in the pediatric age range (≤ 18 years).…”

An audit of insulin usage and insulin injection practices in a large Indian cohort

“…In a large worldwide survey comprising over 13,000 patients, higher numbers (56.5%) of participants were on insulin, while 40.5% of participants took both insulin and OADs, and minimal numbers used other drugs. [21] Metformin was the highest prescribed OAD (42.65%) which is, however, little less then expected, given that we included only T2DM patients on insulin. Surprisingly, substantial numbers of patients still received SUs in spite of their long duration of diabetes and concomitant insulin prescription indicating its popularity among primary and secondary level practitioners, even at the risk of causing more hypoglycemia.…”

“…[12] Data from a recent large worldwide survey indicated that insulin pen alone was used by 85.6% of patients, while 9.6% used a syringe alone, 2.8% used both, and 1.4% used a pen and another device (usually an insulin pump). [21] Thus, it seems economic condition is a important, but not the sole factor responsible for physicians'/patients' choice and familiarity in using modern devices during insulin therapy.…”