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Original Study
A Short Easy Test Can Detect Ability for Autonomous Insulin Injection by the Elderly With Diabetes Mellitus

https://doi.org/10.1016/j.jamda.2010.10.006Get rights and content

Abstract

Objective

Elderly patients with diabetes often have difficulty with self-administering insulin. It was the aim of the present study to find a short, easy performance test, such as the Timed Test of Money Counting (TTMC), that identifies elderly patients with diabetes, in grade to undertake proper insulin injection autonomously and correctly.

Patients and Methods

A total of 73 insulin-dependent patients (age 77.3 ± 7.1 years, HbA1c 8.2% ± 2.0%) completed the TTMC as part of a comprehensive geriatric assessment before and 3 months after structured diabetes education.

Results

The TTMC showed a sensitivity of 69.2% for autonomous injection of insulin 3 months after diabetes education, if patients performed the test within a time duration of less than 46 seconds. Specificity is 70% and positive predictive value 78.7% in this case.

Study Implication

The TTMC seems to be a suitable predictor for ability to inject insulin autonomously after receiving diabetes education. The expenditure of time is only about 5 minutes and it helps to identify patients with diabetes who are able to inject insulin themselves after diabetes education.

Section snippets

Patients and Methods

One hundred patients with type 2 diabetes mellitus from 6 specific centers were successively included in the study (t0). Two patients withdrew their consent, thus 98 patients were finally included in the statistical analysis (female 65.3%). Inclusion criteria were geriatric patients with insulin-treated type 2 diabetes, and at discharge aged 65 years or older as defined by the Central Association of Geriatrics. According to the definition of 1990, patients showed multimorbidity as well as the

Results

At the follow-up examination (t2), 39 (53.4%) of 73 patients injected insulin autonomously, 28 patients (38.4%) did not. Four patients (5.5%) injected insulin with assistance. Two patients (2.7%) were no longer on insulin therapy and were switched to oral antidiabetic therapy. The patient characteristics of the 39 patients who were able to perform their insulin therapy autonomously, and the 32 patients who could not inject insulin themselves or only with assistance, are presented in Table 4.

Discussion

The TTMC seems to be a suitable predictor for ability to inject insulin autonomously after receiving diabetes education. Indeed, the specificity is 70.0% and the positive predictive value is 78.7% if patients perform the tests within a time period of less than 46 seconds. The TTMC offers a substantial advantage in that it is a very short and nonchallenging performance test. The expenditure of time is only about 5 minutes and it helps to identify patients with diabetes who are able to inject

References (15)

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Cited by (37)

  • Diabetes in Older People

    2018, Canadian Journal of Diabetes
    Citation Excerpt :

    The abdomen is the preferred site for self-injection because it is easier for the older person to landmark. The clock drawing test and other cognitive assessments can be used to predict which elderly people are likely to have problems with insulin therapy (164,165). In older people, the use of prefilled insulin pens as an alternative to conventional syringes (166,167) minimizes dose errors and may improve glycemic control.

  • Psychological insulin resistance in geriatric patients with diabetes mellitus

    2014, Patient Education and Counseling
    Citation Excerpt :

    Besides learning programs both peer education support groups and empowerment programs may help to reduce fear of insulin injection [19]. Comprehensive geriatric assessment (CGA), in particular screening for depression and assessment of cognitive, visual and functional ability by using the timed test of money-counting of Nikolaus et al. is helpful to detect patients ability for insulin self-injection [20]. Furthermore insulin-naïve patients who have switched to insulin therapy have had fewer physical complaints, less worry about the future, a reduced daily struggle and less fear of hypoglycemia, while patients already on insulin therapy showed no improvement [17].

  • Diabetes in Old Age

    2023, Aktuelle Ernahrungsmedizin
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Financial Support for this study was provided by BBraun LTD; there were no conflicts of interest, corporate involvement, or patent holdings regarding this study.

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