The Influence Of Injection Education Interval On Diabetic Patients Using Insulin

Background and AimIt is known that injection education is necessary for diabetic patients treated with insulin.However,research shows that the influence of injection education is difficult to maintain in the long term.Therefore,a reasonable interval for injection re-education is needed to ensure long lasting benefits.The aim of this study was to describe injection techniques and injection education,and to explore the relationship between the interval of injection education and glycemic control among insulin users;and provide evidence for the optimal interval of injection re-education.MethodsThis study is a multi-center,cross-sectional survey based on the study:Prevalence and Risk Factors of Insulin Injection-Related Lipohypertrophy.The demographic information,sociological data,physical examination,injection technique,and laboratory test results of 18 to 80-year old residents who participated in this study were collected and compiled.The data was collected from 4 centers in 4 provinces.Independent sample t test,rank sum test or Pearson chi square test were used for comparison between groups.Regression analysis was used to explore the correlation:linear regression was used for continuous variables and logistic regression was used for binary variables.Data analysis was performed using SPSS 22.0,Graphpad Prism 7.0,and Stata 15.0 statistical software.The differences were considered statistically significant at P<0.05.Results1.Comparison between diabetic Patients in China and the Rest of the WorldAfter excluding data sets with missing values or unclear data,383 participants were included in the statistical analysis.In terms of injection technique,injectionrelated complications and glycemic control: the rate of needle reuse was higher(95.0%vs 47.9%,P < 0.001)in China compared to the rest of the world,while the percentage of patients who received injection education within six months was lower(8.4% vs55.6%,P<0.001).In terms of rotation method,Chinese patients were more in line with the standard than those in the rest of the world(correct site rotation: 96.9% vs 83.2%,correct internal rotation: 80.9% vs 30.5%,P<0.001).The incidence of lipohypertrophy was higher in Chinese patients(52.0% vs 43.7%,P=0.001),pain was more likely to occur during injection(73.9% vs 54.2%,P<0.001).In terms of glycemic control,Hb A1 c in Chinese diabetic patients was significantly lower than that in the rest of the world(7.95 ± 1.7 vs 8.46 ± 2.2,P<0.001).2.The Influence of Injection Education on Diabetic PatientsCompared to patients without injection education,the injection technique of patients with injection education was better.Although there were no statistical differences,the frequency of needle reuse was lower[10.00(4.00,19.00)vs 14.50(6.00,30.00)],the compliance with the required time of needle stay in subcutaneous tissue was higher(64.06% vs 50.00%),the rate of skipping injection was lower(51.01% vs57.89%),and the compliance with the needle direction requirements was higher(93.04%vs 89.47%).Injection related complications were more likely to occur in patients without injection education.Perceived pain was more likely to occur during injection(71.88% vs 92.11%)for these patients.Furthermore,for the same glucose goal,patients without injection education needed to utilize more insulin to achieve the same blood glucose reduction [Hb A1c-7/total daily dose:0.03(0.06)vs 0.05(0.10),Hb A1c-7/total daily dose per kg: 1.82(4.15)vs 3.29(6.96),P<0.05].3.The Influence of Injection Education Interval on Diabetic Patients Using InsulinCompared to patients without injection education more than 6 months,the injection technique of patients with injection education within 6 months was better: the frequency of needle reuse was lower[7.00(3.00,14.00)vs 10.00(4.00,20.00),P<0.05].Injection related complications were more likely to occur in patients without injection education more than 6 months.The number of lipodystrophy[0.44(0.67)vs 0.84(0.95),P<0.05] and lumps(3.13% vs 27.07%,P<0.05)were more likely to found at injection areas,and perceived pain was more likely to occur during injection(59.38% vs 75.21%,P<0.05)for these patients.Comparing different education intervals,the influence of injection education on injection technique gradually weakened with the passage of time: the rate of skipping injection increased(within 6 months: 37.50%,6-12 months: 31.82%,1-2 years: 54.41%,2-5 years: 48.94%,more than 5 years: 57.36%,never received: 57.89%),needle reuse increased[within 6 months:7.00(3.00,14.00),6-12 months:9.00(2.75,17.00),1-2years:6.00(4.00,18.75),2-5 years:8.00(3.00,15.00),more than 5 years:14.00(6.00,20.00),never received:14.50(6.00,30.00)],compliance with the required time of needle stay in subcutaneous tissue decreased(within 6 months: 78.13%,6-12months: 72.73%,1-2 years: 72.06%,2-5 years: 61.70%,more than 5 years: 56.59%,never received: 50.00%)(P < 0.05).The incidence of lipohypertrophy increased(within6 months: 34.38%,6-12 months: 54.55%,1-2 years: 48.53%,2-5 years: 57.45%,more than 5 years: 59.69%,never received: 42.11%),and pain was more likely to occur during injection(within 6 months: 59.38%,6-12 months: 59.09%,1-2 years: 70.59%,2-5 years: 81.91%,more than 5 years: 70.54%,never received: 92.11%)(P < 0.05).Conclusion1.Compared with the rest of the world,there are still several shortcomings regarding the injection technique of diabetic patients in China,such as excessive needle reuse and more injection-related complications.2.Patients who received injection education had better injection technique and fewer injection complications.For the same glycemic target,patients without injection education needed to utilize more insulin to achieve the same blood glucose reduction.3.The influence of injection education on injection technique loses some impact over time,but further cohort study is needed to verify these results.