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

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


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.


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.


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.

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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.

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Correspondence to Mihoko Matsumura.

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Nakatani, Y., Matsumura, M., Monden, T. et al. Improvement of Glycemic Control by Re-education in Insulin Injection Technique in Patients with Diabetes Mellitus. Adv Ther 30, 897–906 (2013).

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