Insulin Needle Research Articles

Caregiver exposure to hepatitis C virus following transplantation with hepatitis C viremic donor organs: A case series.

Direct-acting antiviral (DAA) therapeutics have ushered in an era in which transplanting organs from donors infected with hepatitis C virus (HCV+) into recipients without (HCV-) is an increasingly common practice. Rare but potentially life-threatening events have been reported in recipients of HCV+ organs. Since 2018 at our institution, 182 HCV- patients have received HCV+ donor organs. Here, we retrospectively reviewed cases in which recipients' family member caregivers reported sustaining needlestick exposures at home following discharge of the transplant recipient from the hospital. Caregiver needlestick exposures were passively reported in three cases of HCV+ into HCV- transplants (1.64% of such cases at our center). In all instances, the exposed individuals were aiding in diabetic management and the exposure occurred via lancets or insulin needles. In one case, the recipient viral load was undetectable at the time of the exposure but in the other two, recipients were viremic, putting their family members at risk to contract HCV infection. Surveillance for the exposed individuals was undertaken and no transmissions occurred. For centers performing HCV+ into HCV- transplants, it is important that informed consent includes discussion of potential secondary risks to family members and caregivers. Further, protocols for postexposure surveillance and for the acquisition of DAA treatment in the event of a secondary transmission should be in place.

Tailor-made insulin needles and reconsidering patient guidance: A case in which good treatment progress was obtained by switching the patient from Micro-Fine™ Plus to Pen Needle® Plus

Tailor-made insulin needles and reconsidering patient guidance: A case in which good treatment progress was obtained by switching the patient from Micro-Fine™ Plus to Pen Needle® Plus

Performance evaluation of case definitions of type 1 diabetes for health insurance claims data in Japan

BackgroundNo case definition of Type 1 diabetes (T1D) for the claims data has been proposed in Japan yet. This study aimed to evaluate the performance of candidate case definitions for T1D using Electronic health care records (EHR) and claims data in a University Hospital in Japan.MethodsThe EHR and claims data for all the visiting patients in a University Hospital were used. As the candidate case definitions for claims data, we constructed 11 definitions by combinations of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. (ICD 10) code of T1D, the claims code of insulin needles for T1D patients, basal insulin, and syringe pump for continuous subcutaneous insulin infusion (CSII). We constructed a predictive model for T1D patients using disease names, medical practices, and medications as explanatory variables. The predictive model was applied to patients of test group (validation data), and performances of candidate case definitions were evaluated.ResultsAs a result of performance evaluation, the sensitivity of the confirmed disease name of T1D was 32.9 (95% CI: 28.4, 37.2), and positive predictive value (PPV) was 33.3 (95% CI: 38.0, 38.4). By using the case definition of both the confirmed diagnosis of T1D and either of the claims code of the two insulin treatment methods (i.e., syringe pump for CSII and insulin needles), PPV improved to 90.2 (95% CI: 85.2, 94.4).ConclusionsWe have established a case definition with high PPV, and the case definition can be used for precisely detecting T1D patients from claims data in Japan.

Subclinical lipohypertrophy--Easily ignored complications of insulin therapy.

Subclinical lipohypertrophy is a lesion meeting ultrasonic criteria for lipohypertrophy that was not detected by inspection and palpation. Little information is published on subclinical lipohypertrophy among insulin injection people with diabetes. We aimed to investigate the subclinical lipohypertrophy prevalence, risk factors, and the association between subclinical lipohypertrophy and glycemic control. This observational study included 316 people with diabetes who had continuously received insulin therapy for at least one year. We performed ultrasound scanning and clinical examination for evidence of subclinical lipohypertrophy. Demographic characteristics, clinical information, and glycated hemoglobin were measured. The overall prevalence of subclinical lipohypertrophy was 19.9%. By stepwise logistic regression, higher BMI (OR = 1.44, 95%CI: 1.15-1.81, P = 0.002), incorrect rotation of sites (OR = 3.11, 95%CI: 1.02-9.47, P = 0.046), insulin needle reusage for more than four times (OR = 10.00, 95%CI: 3.23-31.02, P = 0.000) and type 1 diabetes (OR = 6.33, 95%CI: 1.32-30.47, P = 0.021) remained associated with subclinical lipohypertrophy. Subclinical lipohypertrophy demonstrated a significant independent correlation with the nonoptimal glycemic control (OR = 9.97, 95% CI: 3.46-28.75, P = 0.000) when accounting for demographic and diabetes-related parameters. Subclinical lipohypertrophy is common among insulin-injecting patients with diabetes and is related to glycemic control deterioration. Ultrasonography may be an ideal adjunct in the evaluation of easily ignored lipohypertrophy lesions, especially where poor glycemic control, incorrect injection behaviors, overweight or obesity are documented.

Comparison of subcutaneous sterile water injection versus normal saline water injection over the sacrum in females presenting with severe back pain undergoing normal vaginal delivery at term.

Objectives: Compare the mean pain score with subcutaneous sterile water injection versus normal saline water injection over the sacrum in females presenting with severe back pain undergoing normal vaginal delivery at term. Study Design: Randomized Control Trial. Setting: MCH Centre, Pakistan Institute of Medical Sciences, Islamabad. Period: 21-08-2019 to 20-11-2019. Material & Methods: The non-probability, consecutive sampling technique was used to include patients. In group A, patients injection was given 4 intracutaneous injections of 0.5 ml sterile water in the lumbar- sacral region in the sitting position. One injection was given at the posterior superior iliac spine on both sides and second injection at 1 cm medial, and 1-2 cm inferior to the first point on both the sides using an insulin needle. These points overlie the area called Michaelis' rhomboid. In group B, patients were given injections of 0.5 ml isotonic saline in the same region using an insulin needle. Then patients were followed-up for 90 minutes (1.5hours). After 90 minutes, pain on VAS was again measured. Results: In this study the mean pain score at baseline of the patient was 79.82±12.99 and the mean pain score after the 90 minutes was 54.05±18.52. Statistically there is highly significant difference was found between the study groups and pain after 90 minutes of the patients i.e. p-value=0.000 Conclusion: Our study results concluded that sterile water group patients showed better pain relief as compared to normal saline group in in females presenting with severe back pain undergoing normal vaginal delivery at term.

Knowledge, Attitude and Practice on Disposal of Sharps Waste at Home Among Patients with Diabetes and their Caregivers.

A recent CDC report estimates that only 17.2% people with diabetes receive insulin. The aim of this study was to evaluate the knowledge, attitude and practice of patients with diabetes and their caregivers towards sharps waste disposal at home. A cross-sectional study was conducted from February to July 2019 at the two main diabetes specialist centers in Taif, Saudi Arabia. Data collected using an interviewer-administered questionnaire, which was designed after a thorough literature review, were used to assess knowledge, attitude and practice using a total of 36 items. 406 patients comprised of mostly females and those who were unemployed, with a mean age of 53.2 +18.5 years and a mean DM duration of 13.6 +8.7 years were included. Approximately <10% reported sharing used insulin needles or lancets as well as accidental family member sticks by the used needle or lancet. More than half of the respondents answered, "I don't know" regarding the knowledge of transmission of hepatitis B or C and HIV by sharing lancet or insulin needles. 52.5%, 51.7% and 47.0% of participants were considered to have high knowledge, high attitude and good practice levels, respectively. 78.8% of participants stated that they disposed of sharps waste in public household garbage bags, and one-third disagreed that they safely collected and brought their used sharps to a hospital. The highest score in the practice section was on optimal needle recap. A partial correlation adjusting to determine the relationship of practice levels with knowledge and attitude levels after controlling for baseline characteristics and duration of DM showed a statistically significant positive correlation between practice and knowledge levels (r = .172, P = .001) while a statistically significant negative correlation between practice and attitude levels (r = - .116, P = .021). Patients with type 1 diabetes exhibited a significantly higher mean score in practice only compared to patients with type 2 diabetes. A partial correlation showed a statistically significant positive correlation between practice and knowledge and a negative correlation between practice and attitude level.

Appropriateness of the 6 mm insulin needle length comparing the glycemic control in overweight-obese and normal weight patients with type 2 diabetes – four years observational study

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Evaluating the User Preference and Level of Insulin Self-Administration Adherence in Young Patients With Type 1 Diabetes: Experience With Two Insulin Pen Needle Lengths.

BackgroundSelecting the appropriate insulin pen needle is important to reduce pain and injection-related adverse events like insulin leakage. It also helps to improve medication adherence and glycemic control in patients with type 1 diabetes mellitus (T1DM).ObjectiveThis study aimed to compare the 6-mm and 8-mm 32.5-gauge insulin pen needles in terms of glycemic control, pain score, user preference, medication adherence, and injection adverse events in patients with T1DM.MethodsWe conducted a prospective cohort study of 62 patients with T1DM. All patients constituted an experimental group initially and then changed the length of the needle to be part of a self-control group. The glycemic control, visual analog scale (VAS) pain score, Morisky Medication Adherence Scale (MMAS) score, needle attribute score, and injection-related adverse events were measured for all patients with both lengths of needles. Patients were assessed at the baseline visit and followed up for three months. Statistical comparisons were done by the chi-squared test, paired t-test, and paired Wilcoxon test when appropriate with a two-tailed alpha level below 0.05 indicating statistical significance.ResultsWith the NanoPass® 32.5-gauge, 6-mm needle (Terumo Corp., Tokyo, Japan), patients had significantly lower glycated hemoglobin (HbA1c) compared to 8-mm needles (7.9% vs. 8.3%; p<0.001). The proportions of patients who reported no hypoglycemic episodes were 22/62 and 9/62, with the 6-mm and 8-mm needles, respectively. The 6-mm needles were better in terms of the following parameters compared to 8-mm needles: mean needle attribute scores (36.7 vs. 24.2; p<0.001), median VAS pain scores (20 vs. 55; p<0.001), insulin leakage (6/62 vs. 20/62; p=0.002), and the MMAS score (4.9 vs. 3.4; p<0.001).ConclusionThis study provided an overview of the safety, adherence, pain score, and glycemic control relating to the 6-mm and 8-mm insulin needle lengths. Insulin injections using the NanoPass 32.5-gauge, 6-mm needle were associated with lower pain score, higher patient adherence, fewer adverse events, and better glycemic control compared to the 8-mm needle. Therefore, we recommend the use of the NanoPass 6-mm needle for patients with T1DM. Further studies are needed to confirm these findings in patients with type 2 diabetes mellitus (T2DM).

Comparative Analgesic Effects of Intradermal and Subdermal Injection of Sterile Water on Active Labor Pain.

BackgroundThe labor pain is one of the factors encouraging pregnant women for cesarean section delivery. Recently, intradermal and subdermal injection of distilled water has shown to be effective in improving this pain.ObjectivesThe present study aimed to determine which method has a greater impact on labor pain reduction.MethodsIn this double-blind, randomized clinical trial, 121 nulliparous women with a gestational age of ≥ 37 weeks were randomly divided into three groups: (1) 0.5 cc sterile water injection subdermally at four sacral points with insulin needles (n = 40); (2) 0.5 cc sterile water injection intradermally (n = 39); and (3) needle contact with the mentioned points as the placebo (n = 42). Before the intervention, the VAS score was measured for labor pain, and it was repeated 10, 30, 60, and 90 min after the intervention. The results were compared between the three groups.ResultsBefore the intervention, the mean VAS pain score had no significant difference between the three groups. However, 30, 60, and 90 min after the intervention, the mean pain score was significantly lower in the intradermal and subdermal injection groups than in the control group (P = 0.001); however, the difference between the intradermal and subdermal injection groups was not significant.ConclusionsThe injection of distilled water by either intradermal or subdermal method was associated with a significant reduction in the pain score during labor, but there was no difference between these two methods in terms of decreasing labor pain. As sterile water injection is a safe, effective, and low-cost method, it is proposed to increase the knowledge of midwives and obstetricians about this method.

Injection practices among the diabetes patients on insulin therapy in Chitradurga

Background: Diabetes mellitus has emerged as a global health problem. Insulin is the essential treatment modality for significant number of diabetic patients. Nearly 4 out of 10 patients with T2DM in India are using insulin, either alone or in combination with oral hypoglycemic drugs (OADs). The present study was conducted with the objectives to assess the knowledge and insulin injection practices, risk factors of sharps injury among diabetic patients who are on insulin treatment.Methods: Cross sectional study was conducted at a Basaveshwara hospital, Chitradurga, among diabetic patients on insulin treatment for minimum of past 6 months. Insulin injection technique questionnaire (ITQ) was administered to study participants and proforma was filled by interview technique.Results: 100 patients participated in the study. Syringe and needle device and 6 mm needle are most commonly used devices. 5-10 seconds was the most common duration of time (54%) for which the patients continued to keep the needle inserted in injection site after insulin injection. A 26% patients had lip hypertrophy at injection sites. Among households of the insulin users, a high percentage of children (41%) and house keeper/waste collectors (32%) were at risk of sharps injury. A majority of 55% of the insulin users reported that they didn’t have appropriate disposal containers for the used sharps.Conclusions: A 29% of participants did not practice proper rotation of injection site. Reuse of insulin needles was common practice. Pain/tenderness, lipo-hypertrophy and leakage of insulin after injection were noted at injection site. 10 seconds dwell time was reportedly practiced by only 23%, about half of patients skipped insulin injections and didn’t follow appropriate disposal of used sharps, thereby exposing both family members and waste collectors/handlers to higher risks of sharps injuries.

Effects of hospital-community-family trinity health education model on household disposal of insulin waste needles

Objective To conduct the integrated management of hospital, community and family for patients with insulin injection at home, in order to explore the influence of this trinity health education model on the knowledge of medical waste and the standard disposal of discarded needles. Methods The self-designed questionnaire was used to investigate the knowledge and disposal of medical waste in outpatients, and the causes were analyzed carefully after the problems were found. The hospital, community and family were timely communicated and fed back to the ward and community. After 1, 3 and 6 months of educational intervention, the disposal of insulin needles, the knowledge of medical waste and the recovery of sharp instrument boxes were observed. Results After 1, 3 and 6 months of health education, the final rate of insulin needles mixed into domestic waste was 51.8% (144/278), 15.1% (42/278) and 4.7% (13/278), respectively. Compared with the first result of 99.6% (277/278), the difference was statistically significant (χ2=173.046, 406.136, 502.346, P<0.01); The first survey found that the correct rate of responding to medical waste knowledge items was low. After health education for 1, 3 and 6 months, the correct rate of medical waste related knowledge items was significantly higher than that of the first survey, and the difference was statistically significant (OR=3.016-3 548.810; 95%CI 2.108-917.869, 4.315-19 777.062; χ2=25.180-524.895; P<0.01) ; After 1, 3 and 6 months of health education, the qualified rate of medical waste knowledge was 82.4% (229/278),75.9% (211/278) and 97.1% (270/278), respectively, which was significantly higher than the first result of 6.5% (18/278). The difference was statistically significant (χ2=324.328, 273.712, 453.832, P<0.01). The sharp box recovery of hepatitis B patients was relatively good. Conclusion Hospital-community-family Trinity health education model can improve the breadth and depth of education objects, not only can improve the knowledge of medical waste related to insulin injection patients at home, but also can improve the standardized disposal ability of insulin waste needles. With the passage of time, the effect of health education continues to be good. This integrated health education model is worth popularizing in clinic. Key words: Health education; Medical waste; Standard disposal

Disposal of Used Pens and Needles from Diabetes Patients` Perspective

Introduction:Diabetes as lifelong chronic disease requires pharmacological treatment using plastic pens and needles. Proper disposal of used pens and needles have impact not just on health but environment as well. In 2020 there will be 3.2 million pens used and disposed in Bosnia and Herzegovina resulting in over 600 tons of this waste. Worldwide problem is related to proper disposal of used insulin pens and sharps.Aim:To investigate and evaluate what are the attitudes, knowledge and practices on insulin pens and needles disposal among diabetes patients in Bosnia and Herzegovina.Methods:The research was conducted in five cities in Bosnia and Herzegovina in period December 2019–January 2020 using questionnaire consisted of 28 questions distributed among patients with diabetes through their local patient associations.Results:Total 250 diabetes patients participated. 40.4% inject medicines for 2 times per day and 37.6% for three and more times a day. Patients have not been instructed on proper disposal of used pens or needles in 67.6% and 66% respectively. The most appropriate place to dispose used pens is pharmacies and 90% of respondents would participate in program of collecting used pens if one exists. 75.6% of respondents consider improper disposal of pens and needles as healthcare problem, 18.8% see this as ecological problem and for 4% of them this is not a problem at all.Conclusion:Current practice of disposing used insulin pens and sharps is improper. Patients are aware of health and environmental risk. There is a huge opportunity for pharmacists and other healthcare provides to provide better information and counseling diabetes patients on this topic.

Patterns of Sharps Handling and Disposal Among Insulin-Using Patients With Diabetes Mellitus

The objective of this study was to assess disposal patterns for "sharps" among a cohort of patients with diabetes mellitus (DM) receiving insulin therapy. A convenience sample of inpatients and outpatients was surveyed about how they disposed of sharps, how often they reused lancets and needles, and what education they had received about proper disposal. Safe disposal was defined as discarding sharps into a formal sharps or sealable container; otherwise, disposal was categorized as unsafe. Of 150 respondents, 56% were men and 75% were white. The mean (SD) age was 56 (15) years; duration of DM, 20 (13) years; and hemoglobin A1c, 8.1% (2.0%). Half the respondents reused a lancet two or more times, and 21% reused an insulin needle two or more times. Thirty-eight percent of respondents discarded lancets unsafely, and 33% discarded insulin needles unsafely, typically by throwing these items into household trash. Most respondents (75%) discarded insulin pens, vials, cartridges, insulin pump supplies, and continuous glucose monitor sensors into household trash. Most (64%) indicated that they had not received education on safe sharps-disposal practices, and 84% had never visited their municipal website for information on medical waste disposal. Approximately one-third of patients unsafely disposed of sharps. Unsafe disposal could cause millions of sharps to appear in the municipal solid waste stream, thereby posing a substantial public health hazard. Point-of-care patient education is important, but a broader public health campaign may be required.

In-vivo Intradermal Delivery of Co-57 labeled Vitamin B-12, and Subsequent Comparison with Standard Subcutaneous Administration.

Vitamin B-12 (cobalamin) deficiency in humans is a worldwide problem emanating from varied causes such as insufficient dietary intake or malabsorption of the micronutrient due to an underlying condition (absence or failure of intrinsic factor, atrophic gastritis, post-operative bariatric surgery, inflammatory bowel disease, cobalt deficiency etc.). As oral supplementation is limited by its bioavailability due to the absorptive property of intrinsic factor, clinicians often prescribe parenteral forms of administration to replenish diminished levels rapidly. The gold standard in parenteral delivery of cobalamin is subcutaneous and/or intramuscular injections. The relatively large molecular size of cobalamin (1355.39 Da) makes passive transdermal patch-based delivery via the stratum corneum quite challenging. Hence, the primary goal of this study is to investigate the feasibility of intradermal (ID) delivery of Vitamin B-12 via an almost painless microneedle injection and subsequent comparison with standard subcutaneous (SC) delivery. This work reports on a custom-made microneedle device built from a commercial insulin needle and it's use to perform ID delivery of Co-57 radiolabeled Vitamin B-12 in-vivo in rabbits. The pharmacokinetic profile and bioavailability were studied and compared with SC delivery. It is the first comprehensive study, to our best knowledge, that compares a micronutrient (eg. Vitamin B-12) delivery via ID and SC routes in-vivo. While the bioavailability for the SC route is found to be slightly higher compared to the ID route (99% vs. 96%), the Tmax for both are almost identical. Thus, ID delivery of Vitamin B-12 using a microneedle injection could be a viable and minimally invasive alternative to existing parenteral options.

The reuse of insulin needles: a problem with consequences (about 1000 cases)

The reuse of insulin needles: a problem with consequences (about 1000 cases)

MON-021 Patterns of Sharps Handling and Disposal Among Insulin Using Patients with Diabetes

Background: Nearly 7 million patients with diabetes mellitus (DM) in the U.S. use insulin. Both Insulin therapy and self-monitoring of blood glucose (SMBG) have the potential to generate a large volume of biohazardous waste via use of “sharps” (needles and lancets). Unless safely disposed of these sharps could present a public health risk, placing unaware individuals at risk of needle sticks. However, there is a paucity of data on whether patients safely handle and dispose of used insulin needles and lancets. Objective: Assess patterns of sharps use and disposal among a clinic and hospital based population of DM patients on insulin therapy. Method: A survey was administered to a convenience sample of adult insulin treated DM patients recruited from an outpatient endocrinology clinic and an inpatient hospital setting. Patients were asked about patterns of sharps use (frequency of daily SMBG and insulin injections), how often sharps were used prior to disposal, sharp disposal technique, and education received regarding safe sharp disposal. Results: The survey was completed by 142 patients (94 outpatients and 48 inpatients). Mean age was 56 years, self-reported DM duration 20 years, hemoglobin A1c was 8.4%, and BMI 30.2 kg/m2; 57% were men and 75% were white. No differences in characteristics (p>0.1) were seen between outpatient and inpatient respondents. The average number of insulin injections was 3/day, and frequency of SMBG was 3.5/day. A minority (22%) used an insulin needle 2 or more times, and 32% threw the needles directly into the garbage as opposed to a sealable or red sharps container. Most (56%) respondents used a lancet 2 or more times, sometimes changing the lancet once only every few months. Around a third (35%) threw used lancets directly into the garbage; one patient flushed them down the toilet. No differences were seen between outpatients and inpatients (p> 0.3) in patterns of needle use, lancet use, or disposal method. The majority (63%) of respondents indicated they had never received instruction on safe disposal of sharps. Conclusion: In this population of both outpatients and inpatients, repeated use of the same insulin needle and lancet was noted. Moreover, nearly a third of respondents disposed of their sharps in an unsafe manner. If similar data are confirmed in broader studies, this could translate into a large number of insulin using patients improperly disposing of their sharps waste—a potentially important public health hazard. With the rising prevalence of DM and need for insulin, further study is needed to determine sharps disposal practices of these patients. Improved education is needed on both a population and patient level regarding proper handling of these biohazardous materials.

Home Disposal of Used Insulin Syringes and Needles by the Patients With Diabetic in Rwanda

For many people living with diabetes, using needles to inject insulin and test blood glucose levels is a part of their everyday lives. Improper disposal of these highly contaminating sharp materials can cause injuries to people as well as pollute water sources and agricultural land.Approximately 3.4% of the population in Rwanda lives with diabetes. There is no law specifying how these individuals should dispose of home-used syringes and lancets, and prior to this study, home disposal practices for sharp instruments including needles and lancets used for diabetes self-management were unknown.A cross-sectional study design was used to identify the common methods used by people living with diabetes to dispose of sharps after home use. A total of 201 people living with diabetes participated in the study. Only 107 (53.3%) of them could identify the proper methods of sharp disposal and only 69 (34.3%) reported using these proper disposal methods. The top three challenges to the use of proper disposal practices reported by participants included not being informed of such practices (76, 37.8%), not having appropriate containers (66, 32.8%) and having to travel a long distance to return safety boxes containing sharp materials (47, 23.4%).Future studies should be conducted to understand the financial feasibility of health facility provision of safe disposal boxes for patients. Education focusing on training people living with diabetes to use hard plastic bottles as an acceptable alternative to boxes is also needed. Convenient and effective mechanisms for obtaining and returning used safety boxes should be established. Larger scale studies including more patients could generate more representative data.

A Study on Relationship between Prefilled Insulin Injector and Needle Fitting and Coring Occurrence

A Study on Relationship between Prefilled Insulin Injector and Needle Fitting and Coring Occurrence

Glycemic control, medication adherence, and injection practices among diabetic patients treated in the 3 tertiary referral hospitals in Bhutan: a call for more action

Abstract Background The burden of diabetes has increased rapidly with an increasing cost of treatment. Objectives To describe the glycemic control, injection practices, and treatment adherence among diabetic patients treated with insulin. Methods This cross-sectional study was conducted using a convenience sampling method at the 3 tertiary referral hospitals in Bhutan. Sociodemographic, injection practices, and clinical details were collected. Good glycemic control was defined as glycated hemoglobin A (HbA1c) &lt;7% if available or fasting blood sugar 70–130 mg/dL and 2 h postprandial blood sugar &lt;180 mg/dL if HbA1c values were unavailable. Medication adherence was assessed using the Morisky, Green and Levine (MGL) scale. The injection technique was assessed using a 10-item checklist. Results We studied 207 patients. Good glycemic control was achieved by only 58 (28.0%) of patients. Using the MGL scale score, the objective adherence with insulin therapy was mostly low to medium and a gross discordance was with self-declared adherence (P &lt; 0.001). The injection technique was fair to poor in half of the participants. Those with good injection techniques also had good adherence to medication (P = 0.025, adjusted odds ratio = 4.4, 95% confidence interval 1.2–16.4). The majority (154, 74.4%) had self-injected insulin, while the remaining were dependent on their home caregivers. Forty percent of the participants used storage practices that were not recommended. The disposal of the used insulin needles was generally unsafe. Conclusions Glycemic control and adherence to insulin administration recommendations were poor. The injection technique needs to be improved and standardized, and methods of safe disposal of sharps need to be developed.

Audit of insulin prescription patterns and associated burden among diabetics in a tertiary health institution in Nigeria.

Insulin is one of the most important anti-diabetic agents in the management of diabetes even among type 2 diabetic. There was need to assess insulin adherence, mode of insulin delivery and burden of insulin usage among diabetics. A cross-sectional, prospective questionnaire, orally administered at a Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria. Participants were consecutive patients with diabetes who were 18 years or older presently on insulin either alone or in combination with other anti-diabetic agents for at least 3 months. Baseline demographic and insulin treatment information were obtained. Two hundred and thirteen (213) participants were studied. Of these, 21 (9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 ± 13.1 years, mean duration of diabetes, 7.0 ± 6.9 years). Insulin adherence was noted in 72.8% with better adherence among those who self-injected insulin compared to those who were injected by health care professionals (HCPs) or relations. Among the respondents, 80.8% were on human insulin and pre-mixed insulin was the most commonly used form of insulin (52.6%). Most participants (52.6%) were taking 10-20 units per day, only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6% of the participants. Major reasons for insulin omission were non-availability of insulin and patients being tired of insulin injection. The insulin adherence among diabetics in this study was high. Non-availability of insulin, insulin injection pain and being tired of continual insulin usage were some of the reasons for non-adherent to insulin usage.