Diabetes in India's North East Study: Prevailing Insulin Usage and Insulin Injection Practices amongst Type 2 Diabetes Mellitus Patients.

Abstract

Insulin therapy is mostly advised in patients with poorly controlled type 2 diabetes mellitus (T2DM). However, wide variation exists in insulin practice and usage across the Indian geography. In this cross-sectional study, a retrospective audit of the medical records of T2DM patients who were receiving insulin and attending an urban referral clinic in Northeast India during the period from 2006 to 2017 was conducted to analyze the insulin utilization pattern and injection technique variation. A total of 1,454 patients were included, 60% were male and 40% were female. At presentation, the mean duration of T2DM was 12.13 (7.45) years. Insulin with or without oral anti-diabetic (OADs) was received by 52.27% and 47.73% of patients, respectively. The majority (62.93%) used a pen device for insulin administration. The patient-reported reasons for insulin therapy initiation were OAD failure (33.15%), glucotoxicity (30.26%) and diabetesassociated complications (20.36%). The mean ± standard deviation (SD) total daily dose (TDD) of insulin was 33.05 ± 17.09 (0.53 ± 0.30 units/kg/day). The breakup for the number of injection(s) per day was one (234,16.09%), two (970,66.71%), three (166,11.42%), four (78, 5.36%), and five (6, 0.41%). The majority (67.88%) used premixed insulin, while 10.90% used basal insulin alone. Compared to those without lipohypertrophy (LH), patients with LH were less likely to rotate the site of injection (0.85 vs 17.90%; p = 0.000), space the injections (10.71 vs 23.91%; p = 0.000), injected less often in correct site (7.81 vs 29.0%; p = 0.000), more likely to use wrong angles (10.08 vs 22.73%; p = 0.000) and reuse the needles (5.63 vs 14.86%; p = 0.000). Also, 34.87% of patients were not storing their insulin device at the right temperature and 8.87% experienced at least one episode of a hypoglycemic event. This audit depicts important attributes of current injection practices amongst T2DM patients on insulin and suggests the possible benefits of adopting correct practices for avoiding complications such as LH and hypoglycemia.