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Nain RA, Thomas DC. Lipohypertrophy prevalence and its associated risk factors in insulin-treated patients with type 2 diabetes in North Borneo, Malaysia. BELITUNG NURSING JOURNAL 2022; 8:521-528. [PMID: 37554235 PMCID: PMC10405654 DOI: 10.33546/bnj.2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 08/10/2023] Open
Abstract
Background Insulin-treated diabetes patients are at high risk of developing lipohypertrophy, which can negatively impact treatment outcomes. Early detection of lipohypertrophy is crucial to preventing blood glucose fluctuation. Unfortunately, this clinical issue is often overlooked by nurses, causing the development of vascular complications, which leads to an increase in the morbidity and mortality of the type 2 diabetes mellitus population. Objective This study was conducted to identify lipohypertrophy prevalence and to establish the association between the presence of lipohypertrophy and its associated risk factors, including years on injection, total injection in a day, total insulin unit per day, often change needle, insulin injection site and move to a different area. Methods This cross-sectional study included 128 patients with type 2 diabetes mellitus who received insulin therapy in an outpatient diabetic clinic. Questionnaires on socio-demographic and lipohypertrophy-associated risk factors were distributed among patients, and lipohypertrophy-assessment was done using a checklist. Descriptive statistics and Pearson Chi-square were used for statistical analysis. Results The prevalence of lipohypertrophy was 51.6% (95% CI: 42.6, 60.5). Swelling on fatty tissue (46.1%) exhibited the highest percentage of lipohypertrophy features during the assessment. Pearson Chi-Square revealed a significant relationship between the presence of LH and BMI categories (χ2 = 10.059, df = 3, p = 0.018), duration of injection (χ2 = 15.001, df = 3, p = 0.002), frequency of needle replacement (χ2 = 9.525, df = 3, p = 0.023) and rotation of injection site (χ2 = 5.914, df = 1, p = 0.015). Conclusion The high prevalence of lipohypertrophy indicates a need for a prevention strategy. Thus, nurses should play an important role in educating patients regarding the proper administration of insulin injections and performing a routine lipohypertrophy assessment and health education on the correct method of insulin injection.
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Affiliation(s)
- Rose A Nain
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Deena Clare Thomas
- Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
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Abujbara M, Khreisat EA, Khader Y, Ajlouni KM. Effect of Insulin Injection Techniques on Glycemic Control Among Patients with Diabetes. Int J Gen Med 2022; 15:8593-8602. [PMID: 36545247 PMCID: PMC9762765 DOI: 10.2147/ijgm.s393597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Previous studies have shown that healthcare professionals rarely instruct patients about proper insulin injection techniques. This study aimed to assess the practices of insulin injection techniques among patients with diabetes treated and assess the effect of these practices on glycemic control. Patients and Methods This cross-sectional study was conducted between November 2020 and February 2021. A random systematic sampling technique was used to recruit study subjects at specialist outpatient clinics. Subjects with type 1 or 2 diabetes mellitus who had been using insulin injections for at least a year were included in this study. Results A total of 298 subjects with type 1 diabetes and 553 with type 2 diabetes participated in this study. The mean age of patients with type 1 diabetes was 20.1 ± 10.4 years. The mean age of patients with type 2 diabetes was 58.6 ± 9.5 years. The median type 1 diabetes duration was 6.0 years, and median type 2 diabetes duration was 15.0 years. About 66.8% of patients with type 1 diabetes and 69.4% of patients with type 2 diabetes were rotating insulin injection sites. Almost 36.6% of patients with type 1 diabetes and 50.5% of patients with type 2 diabetes reported using the same insulin needle more than three times. The prevalence of lipohypertrophy was 57.0% among patients with type 1 diabetes and 55.5% among patients with type 2 diabetes. The absence of lipohypertrophy, rotation of insulin injection site, and total daily insulin dose ≤50 units were all independently significantly associated with better glycemic control. Conclusion Insulin injection techniques were suboptimal among significant proportion of patients with diabetes in Jordan. Improper insulin injection technique, especially the rotation of injection sites and lipohypertrophy formation, was associated with uncontrolled blood glucose levels. Educational interventions that focus on insulin injection techniques among Jordanian patients with diabetes are strongly recommended.
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Affiliation(s)
- Mousa Abujbara
- Department of Diabetes and Endocrinology, the National Centre (Institute) for Diabetes, Endocrinology and Genetics/The University of Jordan, Amman, Jordan
| | - Eiman A Khreisat
- Department of Nursing, the National Centre (Institute) for Diabetes, Endocrinology and Genetics/The University of Jordan, Amman, Jordan
| | - Yousef Khader
- Department of Community Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Kamel M Ajlouni
- Department of Endocrinology and Diabetes, the National Centre (Institute) for Diabetes, Endocrinology and Genetics/The University of Jordan, Amman, Jordan,Correspondence: Kamel M Ajlouni, Department of Endocrinology and Diabetes, the National Centre (Institute) for Diabetes, Endocrinology and Genetics/The University of Jordan, Amman, Jordan, Email
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La Banca RO, Laffel LMB, Volkening LK, C Sparapani V, de Carvalho EC, Nascimento LC. Therapeutic play to teach children with type 1 diabetes insulin self-injection: A pilot trial in a developing country. J SPEC PEDIATR NURS 2021; 26:e12309. [PMID: 32945620 PMCID: PMC7871331 DOI: 10.1111/jspn.12309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Child participation in type 1 diabetes (T1D) self-care is needed in developing countries due to a lack of resources, especially during the school day. This pilot study evaluated the feasibility of a therapeutic play intervention (ITP) versus standard education (SE) on the ability of children with T1D to correctly perform insulin injection technique. DESIGN AND METHODS Children with T1D (7-12 years) were recruited at two diabetes clinics in Brazil and randomized to ITP or SE. Registered nurses received protocol training to deliver the intervention and perform data collection. ITP group received an education that included a story about a child with T1D who self-injects insulin at school; SE group received routine clinic-based education. Preintervention, children were video-recorded giving insulin injections to a doll; postintervention, children were rerecorded giving the doll an injection. The research team reviewed the videos and assessed the injection technique using validated checklists. Parents reported children's self-injection practices at baseline and 30 days. RESULTS Children (N = 20, 40% male) were 9.6 ± 1.3 years old and had T1D for 3.6 ± 2.3 years; HbA1c was 9.1 ± 2.0%; 20% of ITP and 50% of SE children used syringes (vs. pens) for injections. At baseline, 80% of both groups knew how to self-inject; most were taught by a parent/relative. Injection technique scores were low in both groups; ITP group increased their scores significantly postintervention. Practices of self-injection did not change in either group after 30 days. PRACTICE IMPLICATIONS The play-based intervention appeared to improve the injection technique in the short-term. Pilot findings support the development of a larger trial to evaluate the effectiveness of ITP on educating children on insulin injections.
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Affiliation(s)
- Rebecca O La Banca
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA.,Ribeirao Preto College of Nursing, PAHO/WHO Collaborating Center for Nursing Research Development, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Lori M B Laffel
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa K Volkening
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Valéria C Sparapani
- Nursing Department of Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Emilia C de Carvalho
- Ribeirao Preto College of Nursing, PAHO/WHO Collaborating Center for Nursing Research Development, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Lucila C Nascimento
- Ribeirao Preto College of Nursing, PAHO/WHO Collaborating Center for Nursing Research Development, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Hacene MNB, Saker M, Youcef A, Koudri S, Cheriet S, Merzouk H, Lounici A, Alkhatib N. Insulin injection technique in the western region of Algeria, Tlemcen. Pan Afr Med J 2020; 36:327. [PMID: 33193981 PMCID: PMC7603825 DOI: 10.11604/pamj.2020.36.327.21278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/13/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Algeria has more than 1.7 million diabetic patients on to whom a descriptive assessment particularly on the insulin usage behaviors has not yet been initiated, although is needed. This study aims to provide a descriptive analysis of how Algerian diabetic patients perceive and apply insulin injection techniques. Methods using the “patient” questionnaire within the Injection Technique Questionnaire (ITQ) 2016 survey, this study assessed the insulin injection practices of 100 patients recruited over a seven-month period in western Algeria at the Tlemcen University Hospital Center. The results of this study are compared to those of the ITQ 2016 survey. Results pens are the instruments of injection for 98% of Algerians who continue to use mostly long needles of 6- and 8-mm, although 4mm needles are the recommended safer option. Insulin analogues (fast and basal) are plebiscite. Arms and thighs are the preferred injection sites; the abdomen (the preferred site elsewhere) is neglected for reasons to be investigated. The correct re-suspension technique for cloudy insulin is unknown. Extensive pen needle re-use (10+ times) for over half of the patients exposes them to both higher intramuscular (IM) injection risk and lipohypertrophy (LH). Injection training is performed in Algeria by the diabetologist. Conclusion this study describes for the first time Algerian patients´ insulin injection technique. It highlights their skills and identifies many deficiencies which patients and professionals must correct given the issues in this area.
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Affiliation(s)
- Mohammed Nassim Boukli Hacene
- Department of Pharmacy, Faculty of Medicine, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria.,Laboratory of Physiology, Pathophysiology and Biochemistry of Nutrition, Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria
| | - Meriem Saker
- Laboratory of Physiology, Pathophysiology and Biochemistry of Nutrition, Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria
| | - Amina Youcef
- Department of Pharmacy, Faculty of Medicine, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria.,Laboratory of Physiology, Pathophysiology and Biochemistry of Nutrition, Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria
| | - Soumia Koudri
- Department of Pharmacy, Faculty of Medicine, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria
| | - Souad Cheriet
- Department of Pharmacy, Faculty of Medicine, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria
| | - Hafida Merzouk
- Laboratory of Physiology, Pathophysiology and Biochemistry of Nutrition, Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria
| | - Ali Lounici
- Department of Internal Medicine, University Hospital Center Tidjani Damerdji Tlemcen 13000, Algeria.,Laboratory of Research on Diabetes, Faculty of Medicine, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria
| | - Nimer Alkhatib
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, Arizona, USA.,MidCapital Health Care, Amman, Jordan
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Silveira MSVM, Bovi TG, Pavin EJ. Relatively young T1D adults using fixed doses of insulin have higher diabetes distress levels in a sample of patients from a Brazilian tertiary hospital. Diabetol Metab Syndr 2019; 11:104. [PMID: 31890038 PMCID: PMC6909623 DOI: 10.1186/s13098-019-0501-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/04/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Elevated rates of anxiety and depressive symptoms in Type 1 Diabetes patients (T1D) and high rates of diabetes-specific distress (DD) have been shown. Several factors may be responsible for increase the DD levels such as age, life changes, lack of familiar support, education, insulin regimens (IRs) and chronic complications. The goals of this study were: 1-to compare DD levels, anxiety and depressive symptoms according to age (< and ≥ 25 years old), 2-to evaluate the association between DD levels, anxiety and depressive symptoms and IRs, and 3-to evaluate the association between DD levels, anxiety and depressive symptoms and chronic complications. METHODS In a cross-sectional study, T1D patients receiving outpatient care at Unicamp tertiary hospital were included. Inclusion criteria were age at least 18 years old and diagnosis of T1D for 6 months. Exclusion criteria were cognitive impairment, major psychiatric disorders, severe diabetes-related complications, and pregnancy. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D) and the anxiety symptoms by the anxiety subscale of the same instrument (HAD-A). DDS scale assessed DD. Glycemic control was evaluated by HbA1C. The latest lipid panel results were recorded and IRs and chronic complications were obtained through chart review. RESULTS Of all 70 patients, 70% were younger than 25 years old. No differences were found between two groups according to gender, education, and income (p = 0.39, p = 0.87, and p = 0.52, respectively). HbA1c mean was 10% in both groups (p = 0.15). Older patients had higher levels of total DD and physician DD than younger (p = 0.0048 and p = 0.0413; respectively).Total DD and DD on subscales 1 and 2 were higher in patients using fixed doses of insulin compared to variable doses according to carbohydrates count (p = 0.0392, p = 0.0383 and p = 0.0043, respectively). No differences were found between anxiety and depressive symptoms and age and IRs. Similarly, no differences were found among DD levels, anxiety and depressive symptoms in patients with and without chronic complications. CONCLUSIONS When providing education and care for T1D patients, health providers should consider age, patient's developmental stage, with its related demands and the burden of insulin regimen.
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Affiliation(s)
- M. S. V. M. Silveira
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
| | - T. G. Bovi
- Internal Medicine Postgraduate Program, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
| | - E. J. Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences-Unicamp, Campinas, Brazil
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Lecumberri Pascual E, Tejera Pérez C, Muñoz-Garach A, Javier Ampudia-Blasco F. How often patients on insulin therapy measure postprandial glycemia and modify insulin doses accordingly? From an on-line survey in insulin-treated diabetes patients in Spain. Diabetes Res Clin Pract 2019; 154:43-51. [PMID: 31226281 DOI: 10.1016/j.diabres.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/02/2019] [Accepted: 06/13/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Controlling postprandial glycemia (PPG) is important to achieve optimal glycemic control, but few studies have evaluated how often is measured and evaluated. OBJECTIVES To evaluate how often patients on insulin therapy measure PPG and modify insulin doses accordantly. As secondary objectives, we evaluated the factors conditioning elevated PPG and associated issues. MATERIAL AND METHODS Cross-sectional observational study based on a web-based survey from an unselected sample of adult insulin-treated patients. A p-value of < 0.05 was significant. RESULTS 1251 patients (68% women, 38.9 ± 13 years [mean ± SD], body mass index (BMI) 24.2 ± 4.2 kg/m2, diabetes duration 17.4 ± 12.8 years, insulin dose 38 ± 18 IU) participated, 1104 with autoinmmune disease (AD) and 147 with non-autoinmmune diabetes (NAD). 59% of patients had HbA1c ≤ 7%, 92.7% of patients with AD and 55.8% with NAD were attended by specialists (p < 0.001). People with AD did more often blood glucose monitoring (BGM) (p < 0.0001) and used continuous glucose monitoring systems (CGMS) (p < 0.0001). 90.1% with AD and 68.0% with NAD received instructions on measuring PPG (p < 0.001), and more with AD received specific training to change the treatment (87% vs. 61.2%, p < 0.0001) and were more proactive. However, more with NAD discussed their postprandial glucose levels with their healthcare team during clinical visits (92.5% vs. 74.1%, p < 0.0001). Regarding bolus administration, 88.6% with AD and 68.7% with NAD injected the insulin bolus before meals (p < 0.001). CONCLUSIONS Patients with AD determine PPG more frequently. Diabetes type, follow-up setting, number of injections and CGMS use were the most important predictive factors for PPG measurement. Diabetes education programs should address how to best monitor PPG and appropriate corrective actions.
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Affiliation(s)
| | - Cristina Tejera Pérez
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Ferrol, La Coruña, Spain.
| | - Araceli Muñoz-Garach
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Institute of Biomedical Research in Málaga (IBIMA), Málaga, Spain; Instituto de Salud Carlos III, Madrid, Spain
| | - F Javier Ampudia-Blasco
- Diabetes Reference Unit, Endocrinology & Nutrition Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Spain; Medicine Department, Medicine Faculty, University of Valencia, Spain
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