Many individuals with diabetes are not delivering insulin correctly, according to the findings of one of the largest international surveys of people with diabetes ever performed.
Published in the September issue of the Mayo Clinic Proceedings, the survey of more than 13000 insulin users from 42 countries including Australia, reported a number of concerning findings.
1. Needle length and gauge
The survey showed that many people with diabetes who inject insulin are using needles that are longer and thicker than recommended. While there has been a significant shift to shorter needles since a previous 2009 survey, almost 30% of patients are still using longer (8mm) needles, despite the increased risk of intramuscular injection.
2. Needle reuse is common
More than half of pen users and almost 40% of syringe users reuse needles. Of these, around 30% of pen users and 20% of syringe users reuse needles at least 6 times. Needle reuse was associated with unexplained hypoglycaemia, glycemic variability, hyperglycaemia and slightly higher HbA1c levels as well as the presence of lipohypertrophy.
3. Unsafe disposal of sharps
More than half of the survey respondents reporting placing sharps directly in their rubbish bin and of those who initially put them into a designated sharps or other container, 40% then put these into their rubbish bin.
4. Lipohypertrophy is prevalent and problematic
Close to one-third of insulin users were found to have evidence of lipohypertrophy (LH) at their injection sites. Despite taking higher doses of insulin (10 IU per day more) these individuals had an average HbA1c 0.55% higher than those without LH. LH was also associated with higher rates of unexplained hypoglycemia and glycemic variability and more frequent epidoses of DKA.
Less than 30% of patients reported having their injection sites inspected at each visit to their diabetes healthcare team and close to 40% reported not remembering ever having their sites checked.
5. Education is lacking
Proper injection technique is essential to good diabetes management yet less than 40% of patients reported having received education on injection technique in the past 6 months and 10% said they had never received training on how to inject correctly.
“While progress has been and continues to be made, it is clear that there remains considerable room for improvement for the optimisation of insulin delivery practices in patients with diabetes”, write the authors of an accompanying editorial.
The full survey findings are detailed in two papers, one focusing on injection practices and one on injection complications and the role of the health professional. Accompanying these is a third paper with a new set of recommendations for insulin delivery, arising from the recent international Forum for Injection Technique & Therapy Expert Recommendations (FITTER) workshop.
Watch out for our article on the ‘golden rules’ of injection techniques next week.