medwireNews: Directing people with insulin-treated diabetes to online education significantly improves their injection technique and glycemic outcomes linked to injecting into lipohypertrophic areas, a study shows.
The researchers report on 146 people with insulin-treated type 1 (51.4%) or type 2 (48.6%) diabetes who completed the 6-month study. These people were recruited from nine clinics in Belgium, without reference to whether or not they had lipohypertrophy.
Nevertheless, this was present in 63%, say Christophe De Block (Antwerp University Hospital, Belgium) and co-researchers.
The team identified multiple issues with the study participants’ injection technique, including injecting into lipohypertrophic sites (51.4%), incorrectly rotating between injection sites (37.0%), and reusing needles (95.9%, more than 10 times for 15.2%).
By the 6-month follow-up, the rates of these issues had fallen to a corresponding 7.5%, 4.1%, and 21.2%.
“Reuse of needles seems the most difficult to improve,” observe the researchers.
They note that reusing needles is linked to reimbursement issues and indeed 89.7% of participants said they would decrease their needle reuse if pen needles were reimbursed.
For the study, all participants were supplied with free 4 mm pen needles on a one per injection basis. Around half (51.4%) were already using 4 mm needles, although needles of up to 8 mm were also in use.
“Shorter needles (4-mm) can reduce the risk of [intramuscular] injection and have been shown to be safe with good glycaemic control and to reduce pain and patients’ fear of injection,” write the researchers in Diabetic Medicine.
The participants were also given access to an online educational platform (BD and Me™) to refresh their knowledge of correct injection technique. The vast majority (92.6%) completed at least one online educational module, with 36.4% completing all eight and 49.6% more than four.
De Block and team found that improvements in injection technique at the 6-month assessment did not correspond to the number of modules completed.
“At first sight, this seems counterintuitive,” they say. “However, people with a high knowledge at baseline probably did not need a lot of additional education as opposed to those with limited knowledge and skills at baseline.”
In addition to the improved injection technique, the participants also achieved a significant reduction in the rate of severe hypoglycemic events (from 15.8 to 4.1%), of unexplained hypoglycemic events (46.6 to 16.4%), and of high glucose variability (64.4 to 29.5%) from baseline to 6 months.
The average glycated hemoglobin (HbA1c) level did not improve during the course of the study, but the researchers attribute this to the relatively low baseline levels (average 7.5%, 58 mmol/mol).
However, they found that in the 67 people with HbA1c above this average level, there was a significant reduction from 8.5% to 8.2% (69 to 66 mmol/mol), without a change in insulin dose, “meaning that with the same total insulin dose a better metabolic control could be achieved.”
De Block and team conclude: “We believe that inadequate knowledge of the patient about the importance of lipohypertrophy is a significant factor in the development of lipohypertrophy and its associated complications.
“Therefore it is important to educate the patient about the fact that injecting into a lipohypertrophy zone alters the kinetics of insulin release which may lead to higher insulin needs, more unexplained hypoglycaemia and increased glucose variability.”
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