SAT-145 Insulin Technique Assessment and Its Association with Glycemic Control amongst Inpatients with Diabetes

Abstract

Introduction: Suboptimal glycemic control continues to be an ongoing problem in diabetes care. Poor glycemic control can be caused by a myriad of reasons including improper insulin storage or poor insulin pen technique. The Worldwide Injection Technique Questionnaire Study revealed a high level of poor insulin injection among participants, as well as a high prevalence of injecting complications such as lipohypertrophy (LH).1 The primary objective of this study was to evaluate the injection technique of a sample of inpatients; the secondary objective was to assess the relationship between injection skill accuracy and glycemic control. Methods: Participants were inpatients admitted to med-surgical units at an urban quaternary care center. Included were those with type 1 (T1DM) or type 2 diabetes (T2DM), aged 18 to 75 that were using an insulin pen for at least 3 months. Subjects were given a questionnaire about glycemic control, insulin pen education, and diabetes characteristics. Injection skill was assessed using an institutional competency checklist. Poor glycemic control was defined as HbA1c ≥ 9.0, any hospitalization for uncontrolled diabetes within the past year and occurrence of hypoglycemia within the last month. For insulin skill, those who achieved 80% or higher (75th percentile) were classified as high performers and those below were deemed poor performers. Data was analyzed using descriptive statistics. Results: 100 study subjects with mostly T2DM (90%) and a mean age of 58.7 years were consented. Majority of patients (n=67) were in the poor performer category while 28 were high performers (5 were excluded). There was no association between poor technique and glycemic control. However, a greater number of poor performers had at least 1 hospitalization for uncontrolled diabetes within the past year (21% vs 11%) (p=0.238). A larger number of those with poor technique were more likely to have had a hypoglycemic episode within the past month (66% vs 61%) (p=0.645). Majority of participants received initial pen training from an endocrinologist or primary care physician (PCP); most of which had never received reinforcement. Those with poor technique were using higher amounts of insulin (total daily dose over 50 units). Conclusion: This pilot study suggests that improved injection training has potential to reduce hospitalizations and episodes of hypoglycemia. The results highlight the overall lack of proper training and reinforcement and the need to emphasize its importance. A follow up study with a larger sample may have better ability to detect statistical significance.