Abstract
IntroductionImproper injection technique can negatively affect glycemic control and treatment tolerability. We assessed the impact of structured insulin injection training on glycemic control.MethodsWe compared changes in glycated hemoglobin (A1C) and fasting plasma glucose following structured insulin injection training in a 6-month pilot study in patients with type 1 or 2 diabetes. Patients were recruited from mobile clinics in Moscow, Russia, and randomized into three groups. Groups 1 and 2 received structured injection training, and group 3 did not. Group 1 received 4-mm needles sufficient for each injection; groups 2 and 3 provided their own needle supply. Changes in insulin total daily dose (TDD), injection technique, needle reuse, and lipohypertrophy (LH) were assessed.ResultsOf 120 patients enrolled, 116 were included in all analyses (group 1, n = 43; group 2, n = 35; group 3, n = 38). At 6 months, mean [95% CI] reductions in A1C were significant in groups 1 and 2 (− 1.00% [10.9 mmol/mol (− 1.3 to − 0.6)] and − 1.00% [10.9 mmol/mol (− 1.4 to − 0.7)], respectively; P < 0.001 for both), but not in group 3 (− 0.02% [0.2 mmol/mol (− 1.2 to 1.6)]). Increases in insulin TDD, however, were similar and significant across groups (approximately 6 IU; P < 0.05). Injection technique improved, and needle reuse and LH declined in groups 1 and 2, but not in group 3.ConclusionsLittle is known about the glycemic impact of insulin injection training. We found that structured training and the use of short pen needles can improve injection technique, leading to significant A1C reductions and decreased rates of LH.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0315-y) contains supplementary material, which is available to authorized users.
Highlights
Improper injection technique can negatively affect glycemic control and treatment tolerability
We found that structured training and the use of short pen needles can improve injection technique, leading to significant A1C reductions and decreased rates of LH
Insulin therapy is an essential part of treatment for many patients with diabetes mellitus (DM)
Summary
Improper injection technique can negatively affect glycemic control and treatment tolerability. We assessed the impact of structured insulin injection training on glycemic control. Methods: We compared changes in glycated hemoglobin (A1C) and fasting plasma glucose following structured insulin injection training in a 6-month pilot study in patients with type 1 or 2 diabetes. Groups 1 and 2 received structured injection training, and group 3 did not. Insulin therapy is an essential part of treatment for many patients with diabetes mellitus (DM). Diabetes Ther (2017) 8:1309–1318 life-long insulin therapy, and those with type 2 DM (T2DM) often become insulin dependent as their disease progresses [1]. Previous evaluations of self-management programs have not assessed the glycemic impact of providing insulin injection training, this is an essential aspect of DSME [5, 6]. International and national recommendations for proper insulin injection technique are widely available [7,8,9]; it is commonly recognized that a substantial proportion of patients receiving usual care receive minimal injection training [10] and do not inject insulin properly [11]
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