Lu Yuan, Fengfei Li and Ting Jing contributed equally to this article.
To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.7182269
Patients with type 2 diabetes (T2D) receiving premixed insulin often fail to achieve optimal glycemic control. The insulin injection technique (IT) itself may be one of the factors affecting glycemic variability (GV). The aim of this study was to assess the relationship between GV and IT in patients with T2D using premixed insulin.
This was a single center, cross-sectional, and self-controlled trial. Patients with T2D using premixed insulin were enrolled as inpatients. The 4-day study consisted of a 2-day patient insulin injection period (days 0 and 1) and a 2-day specialist nurse insulin injection period (days 2 and 3). Patient insulin IT were assessed on day 1 by two independent nurses using a skill-related scale consisting of 15 items, with a maximum score for each item of 2 and a total optimum score of 30. All patients underwent 96-h continuous glucose monitoring (CGM) during the 4-day study, and CGM data collected on days 1 and 3 were recorded and analyzed. The primary outcome was the relationship between the insulin IT score and the 24-h mean amplitude glycemic excursion (MAGE) during the patient injection period.
A total of 52 inpatients with T2D who used premixed insulin were recruited and completed the study. The mean total insulin IT score of these patients was considerably lower than the optimum score (17.0 ± 4.4 vs. 30). Our CGM data showed that the MAGE was significantly higher during the patient injection period than during the nurse injection period (P < 0.05). Multiple linear stepwise regression analysis showed that the patient IT score was negatively correlated to the MAGE (P < 0.05). The patient IT score was also negatively correlated to glycated hemoglobin (HbA1c; P < 0.05).
A poorer insulin IT may negatively affect GV and HbA1c control in patients with T2D using premixed insulin. Our data indicate that the insulin IT is important for short- and long-term glycemic control.
ClinicalTrials.gov identification number: NCT03513055.
Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271–81. CrossRef
Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362(12):1090–101. CrossRef
Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948–59. CrossRef
Suh DC, Choi IS, Plauschinat C, Kwon J, Baron M. Impact of comorbid conditions and race/ethnicity on glycemic control among the US population with type 2 diabetes, 1988–1994 to 1999–2004. J Diabetes Complicat. 2010;24(6):382–91. CrossRef
Guo XH, Yuan L, Lou QQ, et al. A nationwide survey of diabetes education, self-management and glycemic control in patients with type 2 diabetes in China. Chin Med J (Engl). 2012;125(23):4175–80.
Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364–79. CrossRef
Qiao Q, Nakagami T, Tuomilehto J, et al. Comparison of the fasting and the 2-h glucose criteria for diabetes in different Asian cohorts. Diabetologia. 2000;43(12):1470–5. CrossRef
He X, Chen L, Wang K, Wu H, Wu J. Insulin adherence and persistence among Chinese patients with type 2 diabetes: a retrospective database analysis. Patient Prefer Adherence. 2017;11:237–45. CrossRef
Frid AH, Hirsch LJ, Menchior AR, Morel DR, Strauss KW. Worldwide injection technique questionnaire study: population parameters and injection practices. Mayo Clin Proc. 2016;91(9):1212–23. CrossRef
Frid AH, Hirsch LJ, Menchior AR, Morel DR, Strauss KW. Worldwide injection technique questionnaire study: injecting complications and the role of the professional. Mayo Clin Proc. 2016;91(9):1224–30. CrossRef
Huang Y, Heng C, Wei J, et al. Influencing factors of glycemic variability in hospitalized type 2 diabetes patients with insulin therapy: a strobe-compliant article. Medicine. (Baltimore). 2017;96(36):e8021. CrossRef
Dagdelen S, Deyneli O, Olgun N, et al. Turkish insulin injection techniques study: complications of injecting insulin among turkish patients with diabetes, education they received, and the role of health care professional as assessed by survey questionnaire. Diabetes Ther. 2018;9(4):1615–28. CrossRef
Di Flaviani A, Picconi F, Di Stefano P, et al. Impact of glycemic and blood pressure variability on surrogate measures of cardiovascular outcomes in type 2 diabetic patients. Diabetes Care. 2011;34(7):1605–9. CrossRef
Esposito K, Nappo F, Marfella R, et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation. 2002;106(16):2067–72. CrossRef
Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295(14):1681–7. CrossRef
Frid AH, Kreugel G, Grassi G, et al. New insulin delivery recommendations. Mayo Clin Proc. 2016;91(9):1231–55. CrossRef
Ji J, Lou Q. Insulin pen injection technique survey in patients with type 2 diabetes in mainland China in 2010. Curr Med Res Opin. 2014;30(6):1087–93. CrossRef
Omori K, Kawamura T, Urata M, et al. Effect of re-coaching on self-injection of insulin in older diabetic patients—impact of cognitive impairment. Diabetes Res Clin Pract. 2017;130:34–42. CrossRef
Poudel RS, Shrestha S, Piryani RM, Basyal B, Kaucha K, Adhikari S. Assessment of insulin injection practice among diabetes patients in a tertiary healthcare Centre in Nepal: a preliminary study. J Diabetes Res. 2017;2017:8648316. CrossRef
Li FF, Fu LY, Zhang WL, et al. Blood glucose fluctuations in type 2 diabetes patients treated with multiple daily injections. J Diabetes Res. 2016;2016:1028945. PubMed
Jehle PM, Micheler C, Jehle DR, Breitig D, Boehm BO. Inadequate suspension of neutral protamine Hagendorn (NPH) insulin in pens. Lancet. 1999;354(9190):1604–7. CrossRef
Brown A, Steel JM, Duncan C, Duncan A, McBain AM. An assessment of the adequacy of suspension of insulin in pen injectors. Diabet Med. 2004;21(6):604–8. CrossRef
Springs MH. Shake, rattle, or roll? Am J Nurs. 1999;99(7):14–6. CrossRef
Nath C. Mixing insulin: shake, rattle, or roll? Nursing. 2002;32(5):10. CrossRef
Lucidi P, Porcellati F, Marinelli Andreoli A, et al. Pharmacokinetics and pharmacodynamics of NPH insulin in type 1 diabetes: the importance of appropriate resuspension before subcutaneous injection. Diabetes Care. 2015;38(12):2204–10. CrossRef
Blanco M, Hernandez MT, Strauss KW, Amaya M. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab. 2013;39(5):445–53. CrossRef
Kalra S, Mithal A, Sahay R, et al. Indian injection technique study: injecting complications, education, and the health care professional. Diabetes Ther. 2017;8(3):659–72. CrossRef
Wang W, Guo X, Shen G, et al. Skin and subcutaneous tissue thickness at insulin injection sites in Chinese diabetes patients: clinical implications. Diabetes Metab. 2016;42(5):374–7. CrossRef
Ji L, Sun Z, Li Q, et al. Lipohypertrophy in China: prevalence, risk factors, insulin consumption, and clinical impact. Diabetes Technol Ther. 2017;19(1):61–7. CrossRef
- Insulin Injection Technique is Associated with Glycemic Variability in Patients with Type 2 Diabetes
- Springer Healthcare
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II