Pharmaceutical Science: Research Trends and Challenges Vol. 1

Background: Correct insulin injection technique is vital for effective diabetes management and the prevention of cutaneous complications. Nevertheless, deviations from recommended injection guidelines remain widespread in real-world clinical practice.

Aims: This study aimed to assess insulin injection techniques in diabetic patients and to identify factors associated with glycaemic control and injection pain.

Study Design and Setting: This descriptive cross-sectional study was conducted in the Endocrinology and Nutrition Department of the Military Hospital of Tunis, Tunisia, over a two-month period from January to February 2023.

Methodology: We included 50 patients (28 men and 22 women; age range, 24–85 years) with type 1 diabetes or insulin-requiring type 2 diabetes. The 30-item questionnaire was adapted from the “Updated 2017 French Diabetes Society Paramedical Best Practice Guidelines”. It covered insulin storage, injection sites, filling and priming techniques, injection practices, post-use waste management, and injection pain assessed using the Visual Analogue Scale.

Results: The mean age was 56.4 ± 19.4 years, and the mean duration of diabetes was 13.3 years, with a mean HbA1c of 10.2%. The mean duration of insulin therapy was 7.4 ± 5.5 years; the regimens were bedtime insulin (22%), basal insulin (36%), basal-plus (20%), and basal-bolus (22%). The mean number of daily injections was three (range, one to six). Thirty-three patients had received education, mainly regarding insulin storage (78.8%) and injection-site selection (63.6%). Only 20% of patients rotated injection sites regularly, 14% systematically screened for lipodystrophy, and 48% used the skin-fold technique; needle reuse and unsafe waste disposal were reported by 86% and 94%, respectively.

Glycaemic control was associated with injection-site rotation (P = .01), injection into lipodystrophic areas (P = .03), and use of the skin-fold technique (P = .01). The presence and intensity of injection pain were associated with the mean number of injections per needle (P = .04 and P = .001, respectively).

Conclusion: Substantial knowledge and practice gaps remain in insulin administration among patients with diabetes. Structured therapeutic education programmes in diabetes clinics and inpatient units are needed to address these deficiencies.