The management of insulin administration: systematic review and recommendations

Abstract

In spite of the large prevalence and increasing incidence of diabetes, recommendations on how to correctly administer the insulin are lacking. METHODS; A systematic literature review was performed starting from a list of clinical questions collected from patients, clinical experts (doctors and nurses) and others involved in diabetic patients care. The main databases were searched with the following key-words: Insulin/administration and dosage[Mesh]; "Injections, Subcutaneous/instrumentation"[Mesh]; "Injections, Subcutaneous/methods"[Mesh]; insulin administration modalities [All Fields]; insulin administration technique [All Fields]; insulin adsorption[All Fields]; Patient education as a topic/methods [Mesh]. The articles were independently analyzed by three authors and discrepancies discussed. A list of recommendations was produced weighting the evidences according to the Italian National Program for Guidelines method. Over 94 eligible articles, 71 were included. Recommendations for the following areas were produced: self management and education; tools and methods for insulin administration; injection sites; injection techniques; prevention and management of complications; insulin storage; management of IV infusions. Most recommendations are of level II (a single RCT with adequate design) or III (cohort non randomized studies with concurrent or historical controls). Although several recommendations were identified (e.g., the importance of rotation of injection sites, the criteria for choosing the right needle and injection site according to the type of insulin and speed of absorbtion), several questions are still unanswered and would warrant further and more specific studies.