Correcting insulin injection technical failures in the treatment of diabetic patients, how much effective?

Abstract

Aim: The aim of this study was to determine the frequency of treatment-related errors and to investigate the effect of diabetes education and close patient follow-up on glycemic control in diabetic patients using insulin, with insufficient glycemic control Methods: The patients who were admitted to Dr.Ersin Arslan Training and Research Hospital, Department of Endocrinology and Metabolic Diseases between 2016 and 2018, who had uncontrolled diabetes, using high-dose insulin, and who were included in the diabetes education program were included in the study. Patients' demographic characteristics, diabetes duration, diabetic complications, HbA1c levels, total insulin doses they used, number of oral antidiabetic drugs, as well as incorrect technique applications during insulin injection were recorded. The presence of lipohypertrophy and lipoatrophy in the insulin injection sites determined at admission of the patients were recorded. The last HbA1c levels, total insulin doses they used and the number of oral antidiabetic drugs they used were also recorded. Results: 118 patients with uncontrolled diabetes who were using insulin were included in the study. The mean duration of diabetes was 11.3 (1-70) months. 11.0% of the patients had received diabetes education by the education nurse at least once. HbA1c averages were 10.7% (5.6-15.9), and the average insulin dose was 71.2 units / day. The patients were on average 1.1 oral antidiabetic drugs in addition to insulin. The most common error was using improper insulin injection site (68.6%). In 11.0% of patients, lipohypertrophy was found in insulin injection sites and lipoatrophy in insulin injection sites in 6.8% of patients. When 33 patients with follow-up data were evaluated; There was a significant decrease in HbA1c levels (11,3 ± 1,5 vs 9,3 ± 1,8; p <0,001). There was a statistically significant decrease in daily insulin dose (77 units vs 64.4 units; p = 0.002). Conclusion: In our study, an improvement of 2% was found in HbA1c levels despite decreasing insulin doses by correcting the errors in insulin injection technique. In addition to the regulation of medical treatments of patients, correction of technical applications is also effective in glycemic control.