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Advances in Therapy

, Volume 30, Issue 10, pp 897–906 | Cite as

Improvement of Glycemic Control by Re-education in Insulin Injection Technique in Patients with Diabetes Mellitus

  • Yuki Nakatani
  • Mihoko Matsumura
  • Tsuyoshi Monden
  • Yoshimasa Aso
  • Takaaki Nakamoto
Original Research

Abstract

Introduction

The aim of this study was to evaluate the effectiveness of re-education in the insulin injection technique for glycemic control.

Methods

A preliminary experimental study was performed with 87 insulin-treated diabetic outpatients (11 with type 1 diabetes, 76 with type 2 diabetes; 43 men, 44 women). All patients had been treated with insulin for more than 3 years. After answering questions about the insulin injection technique, the patients’ knowledge levels were scored. Correct answers and explanation sheets were subsequently given to all patients. The physicians in charge gave a short lecture and provided 10 min of individual advice. Two, three, and four months after re-education the HbA1c and glycoalbumin levels were measured.

Results

The mean HbA1c levels of almost all patients significantly improved from 7.46 ± 0.09% to 6.73 ± 0.10% (P < 0.01), and the mean glycoalbumin levels significantly improved from 22.76 ± 0.50% to 20.26 ± 0.68% (P < 0.01). Twenty-five patients demonstrated a poor understanding (score of ≤6 points) and showed a significant decrease in the HbA1c level from 7.62 ± 0.20% to 6.71 ± 0.21% (P = 0.02). Forty-three patients demonstrated a moderate understanding (score of 7 or 8 points) and showed a decrease in the HbA1c level from 7.40 ± 0.13% to 6.68 ± 0.07% (P = 0.07). Finally, 19 patients demonstrated a good understanding (score of ≥9 points) and showed a slight decrease in the HbA1c level from 7.38 ± 0.15% to 6.93 ± 0.12% (P = 0.09). Patients with a poor understanding showed the largest decrease in the mean level of HbA1c.

Conclusion

Re-education in the insulin injection technique led to an improvement in glycemic control in insulin-treated diabetic patients, especially in those with a poor understanding of the insulin injection technique. More attention should be paid to these strategies for outpatients.

Keywords

Diabetes mellitus Glycemic control Insulin Insulin injection technique Re-education 

Notes

Acknowledgments

Dr. Yuki Nakatani is the guarantor for this article, and takes responsibility for the integrity of the work as a whole. Medical writing assistance was provided by Angela Morben of Edanz® and was funded by Dr. Yuki Nakatani.

Conflict of interest

Yuki Nakatani, Mihoko Matsumura, Tsuyoshi Monden, Yoshimasa Aso, and Takaaki Nakamoto declare that they have no conflicts of interest. No funding or sponsorship was received for this study or publication of this article.

Compliance with ethical guidelines

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 and 2008. Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Yki-Jarvinen H, Kauppila M, Kujansuu E, et al. Comparison of insulin regimen in patients with non-insulin-dependent diabetes mellitus. N Eng J Med. 1992;327:1426–33.CrossRefGoogle Scholar
  2. 2.
    The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.CrossRefGoogle Scholar
  3. 3.
    Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetes microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28(2):103–17.PubMedCrossRefGoogle Scholar
  4. 4.
    National Institue of Health and Nutrition. Outline of the National Health and Nutrition Survey Japan, 2007. http://www.nih.go.jp/eiken/english/research/pdf/nhns2007.pdf. Accessed 18 Oct 2013.
  5. 5.
    International Diabetes Federation. IDF Diabetes Atlas, 5th edn. Brussels, Belgium: International Diabetes Federation, 2011. http://www.idf.org/diabetesatlas. Accessed 18 Oct 2013.
  6. 6.
    Ohara T, Masato K. Topics of insulin therapy—ultra rapid-acting and development of ultra-long-acting insulin [in Japanese]. J Jpn Med Assoc. 2002;128(10):1530–1.Google Scholar
  7. 7.
    Frida A, Hirsch L, Gaspar R, et al. The Third Injection Technique Workshop in Athens (TITAN). Diabetes Metab. 2010;36:S19–29.CrossRefGoogle Scholar
  8. 8.
    De Coninck C, Frid A, et al. Results and analysis of the 2008–2009 Insulin Injection Technique Questionnaire survey. J Diabetes 2010;2:168–79.Google Scholar
  9. 9.
    Hamaguchi T, Namba M. Insulin treatment in elder patients with diabetes. Nihon Rinsho. 2006;64(1):101–5.PubMedGoogle Scholar
  10. 10.
    Hirsch L, Gaspar R, et al. New injection recommendations for patients with diabetes. Diabetes Metab. 2010;38:S3–18.Google Scholar
  11. 11.
    Kawamori R, Matsuhira M, Yamasaki Y. The biology of insulin action in diabetes. In: Turtle JR, Kaneko T, Osato S, editors. Diabetes in the new millennium. Sydney: University of Sydney Press; 1999. p. 73–84.Google Scholar
  12. 12.
    Asakura T, Seino H. Air that was mixed into the insulin cartridge inside (bubble)—the effect that gives the accuracy of the pen-type insulin injection device [in Japanese]. J Jpn Diabete Soc. 2004;47:391–4.Google Scholar
  13. 13.
    American Diabetes Association. Insulin administration: clinical practice recommendation 2000. Diabete Care. 2001;24(suppl1):S94–7.Google Scholar
  14. 14.
    Chantelau E, Heinemann L, Ross D. Air bubbles in insulin pens. Lancet. 1989;2:387–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Koivisto VA, Felig P. Alterations in insulin absorption and in blood glucose control associated with varying insulin injection sites in diabetic patients. Ann Intern Med. 1980;92:59–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Koivisto VA, Felig P. Effects of leg exercise on insulin absorption in diabetic patients. N Engl J Med. 1978;298:79–83.PubMedCrossRefGoogle Scholar
  17. 17.
    Berger M, Halban PA, Assal JP, Offord RE, Vranic M, Renold AE. Pharmacokinetics of subcutaneously injected tritiated insulin: effects of exercise. Diabetes. 1979;28:53–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Koivisto VA, Fortney S, Hendler R, Felig P. A rise in ambient temperature augments insulin absorption in diabetic patients. Metabolism. 1981;30:402–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Berger M, Cuppers HJ, Hegner H, Jorgens V, Berchtold P. Absorption kinetics and biologic effects of subcutaneously injected insulin preparations. Diabetes Care. 1982;5:77–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Koivisto VA. Sauna-induced acceleration in insulin absorption from subcutaneous injection site. Br Med J. 1980;298:1411–3.CrossRefGoogle Scholar
  21. 21.
    Zehrer C, Hansen R, Bantle J. Reducing blood glucose variability by use of abdominal insulin injection sites. Diabetes Educ. 1990;16(6):474–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Kordonouri O, Lauterborn R, Deiss D. Lipohypertrophy in young patients with type 1 diabetes. Diabetes Care. 2002;25(3):643.CrossRefGoogle Scholar
  23. 23.
    Hauner H, Stockamo B, et al. Prevalence of lipohypertrophy in insulin-treated diabetic patients and predisposing factors. Exp Clin Endocrinol Diabetes. 1996;104:106–10.PubMedCrossRefGoogle Scholar
  24. 24.
    McNally PG, Jowett NI, et al. Lipohypertrophy and lipoatrophy complicating treatment with highly purified bovine and porcine insulins. Postgrad Med J. 1988;64(757):850–3.PubMedCrossRefGoogle Scholar
  25. 25.
    American Diabetes Association. Insulin administration. Diabetes Care. 2001;24:1984–7.CrossRefGoogle Scholar
  26. 26.
    Strauss K, Hannet I, et al. Ultra-short (5 mm) insulin needles: trial results and clinical recommendations. Pract Diabetes Int. 1999;16:218–22.CrossRefGoogle Scholar
  27. 27.
    Milicevic Z, Profozic V, Wyatt J, et al. Intramuscular injection of insulin lispro or soluble human insulin: pharmacokinetics and glucodynamics in Type 2 diabetes. Diabetes Med. 2001;18(7):562–6.CrossRefGoogle Scholar
  28. 28.
    Annersten M, Frid A. Insulin pens dribble from the tip of the needle after injection. Pract Diabetes Int. 2000;17:109–11.CrossRefGoogle Scholar
  29. 29.
    Le Floch JP, Herbreteau C, Lange F, Perlemuter L. Biologic material in needles and cartridges after insulin injection with a pen in diabetic patients. Diabetes Care. 1998;21:1502–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Hunt LM, Valenzuela MA, Pugh JA. NIDDM patients’ fears and hopes about insulin therapy. Diabetes Care. 1997;20:292–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Schiel R, Mullar UA, Ulbrich S. Long-term efficacy of a 5-day structured teaching and treatment programme for intensified conventional insulin therapy and risk for severe hypoglycemia. Diabetes Res Clin Pract. 1997;35:41–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Healthcare 2013

Authors and Affiliations

  • Yuki Nakatani
    • 1
  • Mihoko Matsumura
    • 2
  • Tsuyoshi Monden
    • 2
  • Yoshimasa Aso
    • 2
  • Takaaki Nakamoto
    • 3
  1. 1.Department of Diabetes and EndocrinologyDokkyo Medical University Nikko Medical CenterTochigiJapan
  2. 2.Department of Endocrinology and MetabolismDokkyo Medical University School of MedicineTochigiJapan
  3. 3.Department of CardiologyDokkyo Medical University Nikko Medical CenterTochigiJapan

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