Introduction
City | Center | Patients |
---|---|---|
Adana | Çukurova Üniversitesi Tip Fakültesi Balcali Hastanesi | 32 |
Afyon | Afyon Kocatepe Üniversitesi Hastanesi | 31 |
Amasya | Amasya Sabuncuoğlu Şerafettin Eğitim Ve Araştirma Hastanesi | 25 |
Ankara | Ankara Atatürk Eğitim Ve Araştirma Hastanesi | 25 |
Ankara | Dr. Sami Ulus Kadin Doğum, Çocuk Sağliği Ve Hastaliklari Eğitim Ve Araştirma Hastanesi | 37 |
Ankara | Hacettepe Üniversitesi Tıp Fakültesi ErişkiinHastanesi | 32 |
Ankara | Hacettepe Üniversitesi Tıp Fakültesi İhsan Doğramaci Çocuk Hastanesi | 21 |
Ankara | Özel Bayindir Hastanesi | 35 |
Ankara | Dişkapi Yildirim Beyazit Eğitim Ve Araştirma Hastanesi | 25 |
Antalya | Akdeniz Üniversitesi Hastanesi | 25 |
Denizli | Denizli Devlet Hastanesi | 29 |
Antalya | Antalya Eğitim Araştirma Hastanesi | 6 |
Balikesir | Ayvalik Devlet Hastanesi | 18 |
Balikesir | Devlet Hastanesi | 25 |
Bolu | Abant İzzet Baysal Üniversitesi Tip Fakültesi Hastanesi | 25 |
Bursa | Bursa Şevket Yilmaz Eğitim Ve Araştirmahastanesi | 19 |
Bursa | Uludağ Üniversitesi Tip Fakültesi Hastanesi | 33 |
Bursa | Bursa Yenişehir Devlet Hastanesi | 25 |
Çanakkale | Çanakkale Devlet Hastanesi | 16 |
Diyarbakir | Çocuk Hastaliklari Hastanesi | 25 |
Düzce | Atatürk Devlet Hastanesi | 31 |
Edirne | Trakya Üniversitesi Tip Fakültesi Hastanesi | 31 |
Erzurum | Atatürk Üniversitesi Yakutiye Araştirma Hastanesi | 7 |
Eskişehir | Acibadem Eskişehir Hastanesi | 23 |
Eskişehir | Eskişehir Osmangazi Üniversitesi Tip Fakültesi Hastanesi | 26 |
Giresun | Giresun Devlet Hastanesi | 5 |
İstanbul | Acibadem Hastaneleri | 11 |
İstanbul | İstanbul Kanuni Sultan Süleyman Eğitim Ve Araştirma Hastanesi | 6 |
İstanbul | Marmara Üniversitesi Eğitim Ve Araştirma Hastanesi | 25 |
İstanbul | Bağcilar Eğitim Ve Araştirma Hastanesi | 30 |
İstanbul | İstanbul Üniversitesi Cerrahpaşa Tip Fakültesi Hastanesi | 25 |
İstanbul | Haseki Eğitim Ve Araştirma Hastanesi | 30 |
İstanbul | İstanbul Üniversitesi İstanbul Tip Fakültesi Hastanesi | 24 |
İstanbul | Dr. Lütfi Kirdar Kartal Eğitim Ve Araştirma Hastanesi | 25 |
İstanbul | Pendik Kaynarca Semt Polikliniği Diyabet Merkezi | 32 |
İstanbul | Medeniyet Üniversitesi Göztepe Eğitim Ve Araştirma Hastanesi | 26 |
İstanbul | Şişli Hamidiye Etfal Eğitim Ve Araştirma Hastanesi | 25 |
İstanbul | Ümraniye Eğitim Ve Araştirma Hastanesi | 28 |
İzmir | Dokuz Eylül Üniversitesi Tip Fakültesi Hastanesi | 26 |
İzmir | Ege Üniversitesi Tip Fakültesi Hastanesi | 31 |
Kayseri | Erciyes Üniversitesi Tip Fakültesi Hastanesi | 25 |
Kayseri | Kayseri Eğitim Ve Araştirma Hastanesi | 36 |
Kocaeli | Kocaeli Devlet Hastanesi | 25 |
Kocaeli | Kocaeli Üniversitesi Tip Fakültesi Hastanesi | 25 |
Konya | Konya Eğitim Ve Araştirma Hastanesi | 25 |
Konya | Necmettin Erbakan Üniversite Hastanesi Meram Tip Fakültesi | 29 |
Malatya | Malatya Devlet Hastanesi Dahiliye Servisi | 7 |
Mersin | Mersin Devlet Hastanesi | 25 |
Mersin | Mersin Üniversitesi Tip Fakültesi Hastanesi | 31 |
Ordu | Ordu Devlet Hastanesi | 30 |
Samsun | Ondokuz Mayis Üniversitesi Tip Fakültesi Hastanesi | 25 |
Sivas | Cumhuriyet Üniversitesi Tip Fakültesi Hastanesi | 36 |
Sivas | Sivas Numune Hastanesi | 26 |
Tekirdağ | Tekirdağ Devlet Hastanesi | 30 |
Trabzon | Karadeniz Teknik Üniversitesi Tip Fakültesi Farabi Hastanesi | 25 |
Zonguldak | Bülent Ecevit Üniversitesi Uygulama Ve Araştirma Hastanesi | 32 |
TOTAL | 1376 |
Methods
Results
Population Descriptors
Population demographic factors | Mean values for Turkey | Mean ROW valuesa | Turkey (n) | ROWa (n) |
---|---|---|---|---|
Age (years) | 45.0 | 52.7 | 1366 | 11,859 |
BMI (kg/m2) | 28.5 | 26.3 | 1333 | 11,473 |
Mean no. of years with DM | 11.3 | 13.5 | 1289 | 7908 |
Age at diagnosis (years) | 33.6 | 40.6 | 1331 | 11,406 |
Mean no. of years on pills | 10.8 | 8.1 | 366 | 6241 |
Mean no. of years on insulin | 6.9 | 9.0 | 1235 | 7007 |
TDD regular (IU) | 35.9 | 26.1 | 136 | 1286 |
TDD rapid analogs (IU) | 36.0 | 30.9 | 681 | 2786 |
TDD NPH (IU) | 29.3 | 31.7 | 63 | 1071 |
TDD basal analogs (IU) | 25.4 | 28.1 | 917 | 3792 |
TDD premix (IU) | 48.7 | 41.6 | 343 | 1453 |
Overall TDD (IU) | 54.0 | 47.4 | 1251 | 6505 |
HbA1c (%) | 9.10 | 8.35 | 1298 | 6365 |
Patient/HCP identifier | Turkey ITQ (%) | ROW ITQ (%) | Turkey (n) | ROW (n) |
---|---|---|---|---|
Self-injecting adult (≥ 18 years) | 82.4 | 91.8 | 1076 | 7551 |
Self-injecting adolescent (13–17 years) | 10.1 | 4.1 | 132 | 337 |
Self-injecting child (< 13 years) | 3.5 | 2.2 | 46 | 180 |
Parent who gives injections to his/her child | 4.0 | 1.9 | 52 | 157 |
Mean values | Self-injecting adult (> 18 years old) | Self-injecting adolescent (13–17 years old) | Self-injecting child (< 13 years old) | Child receiving Injections from parent | ||||
---|---|---|---|---|---|---|---|---|
Turkey (n = 1076) | ROW (n = 7530) | Turkey (n = 132) | ROW (n = 336) | Turkey (n = 46) | ROW (n = 180) | Turkey (n = 52) | ROW (n = 156) | |
Age (years) | 51.0 | 53.7 | 15.0 | 15.0 | 10.8 | 10.6 | 7.6 | 7.6 |
BMI (kg/m2) | 30.1 | 27.9 | 21.8 | 21.9 | 18.3 | 19.0 | 17.0 | 17.4 |
HbA1c (%) | 9.20 | 8.28 | 8.75 | 9.29 | 8.44 | 8.57 | 7.26 | 8.71 |
TDD (IU) | 56.0 | 48.1 | 52.1 | 55.4 | 37.0 | 37.8 | 24.7 | 22.3 |
Years on insulin | 7.3 | 9.3 | 5.8 | 6.1 | 4.3 | 4.3 | 3.4 | 3.7 |
Needle length | ||||||||
4 mm (%) | 28.1 | 23.3 | 51.0 | 38.1 | 70.7 | 44.3 | 76.1 | 53.7 |
5 mm (%) | 7.9 | 25.6 | 17.0 | 26.6 | 14.6 | 23.5 | 13.0 | 13.4 |
6 mm (%) | 21.1 | 21.9 | 26.0 | 20.2 | 12.2 | 19.1 | 10.9 | 14.6 |
8 mm (%) | 42.9 | 29.3 | 6.0 | 15.1 | 2.4 | 13.0 | 0.0 | 18.3 |
> 4 mm combined (%) | 71.9 | 76.8 | 49.0 | 61.9 | 29.3 | 55.6 | 23.9 | 46.3 |
Devices and Key Injection Practices
Devices used and reuse practice | Turkey | ROW |
---|---|---|
Device (% used) | ||
Syringe | 0.4 | 10.8 |
Pen | 97.3 | 83.9 |
Pump | 1.5 | 2.3 |
Pen and syringe | 0.8 | 3.0 |
Needle length used (mm) | ||
4 | 35.1 | 21.8 |
5 | 9.6 | 39.6 |
6 | 20.6 | 17.7 |
8 | 34.7 | 20.8 |
Needle reuse (%) | ||
Pen | 24.2 | 59.9 |
Syringe | 6.3 | 44.5 |
Number of times pen needle reused | ||
2 | 56.8 | 28.4 |
3–5 | 32.3 | 40.4 |
6–10 | 6.8 | 16.8 |
> 10 | 4.0 | 14.4 |
Mean times a used pen needle is used | 3.42 | 4.98 |
Injections/day and Injection Sites
Number of Injections/day | Turkey (%) | ROW (%) | Turkey (n) | ROW (n) |
---|---|---|---|---|
1 | 9.5 | 17.1 | 129 | 1394 |
2 | 25.6 | 26.1 | 349 | 2131 |
3 | 5.4 | 14.3 | 73 | 1167 |
4 | 50.4 | 30.9 | 688 | 2525 |
5 | 8.3 | 7.6 | 113 | 622 |
6 | 0.6 | 2.3 | 8 | 189 |
> 6 | 0.3 | 1.7 | 4 | 137 |
Injection site used | Turkey (%)a | ROW (%)a | Turkey (n) | ROW (n) |
---|---|---|---|---|
Abdomen | 86.5 | 91.3 | 1158 | 10,449 |
Thigh | 80.1 | 41.9 | 1072 | 4802 |
Buttocks | 20.5 | 13.3 | 275 | 1527 |
Arm | 84.2 | 28.1 | 1127 | 3211 |
Total no. of patients | 1376 | 11,447 | ||
Total sites used by these patients | 3881 | 19,989 |
Injection sites | Turkey | ROW | ||
---|---|---|---|---|
%a |
n
| %a |
n
| |
Abdomen alone | 6.5 | 90 | 46.1 | 5275 |
Thigh alone | 1.6 | 22 | 3.1 | 350 |
Arm alone | 2.7 | 37 | 2.0 | 227 |
Abdomen/thigh | 6.7 | 92 | 17.8 | 2033 |
Abdomen/arm | 8.4 | 116 | 6.4 | 736 |
Thigh/arm | 6.6 | 91 | 2.3 | 267 |
Abdomen/thigh/arm | 44.8 | 616 | 9.0 | 1032 |
Abdomen/buttocks/arm | 1.2 | 16 | 0.9 | 101 |
Thigh/buttocks/arm | 1.9 | 26 | 0.5 | 55 |
All 4 | 16.1 | 222 | 6.8 | 774 |
Injecting Process
Dwell time | Turkey (%) (n = 1357) | ROW (%) (n = 7316) |
---|---|---|
< 5 s | 11.6 | 19.9 |
5–10 s | 37.1 | 47.2 |
> 10 s | 48.3 | 28.9 |
I’m not aware of how long | 2.9 | 4.1 |
Injection sites/skin folds/injection angle | Turkey | ROW |
---|---|---|
Size of injection area (Abdomen)a | ||
Postcard | 11.6 | 57.9 |
Playing card | 37.1 | 19.0 |
Credit card | 48.3 | 15.4 |
Postage stamp | 2.9 | 7.7 |
Injection into a skin foldb | 52.3 | 65.9 |
Injection into skin at 90° anglec | 89.1 | 83.5 |
When released? | Turkey (%) (n = 708) | % ROW ( n = 4737) |
---|---|---|
(1) Once the needle is in the skin | 8.5 | 20.0 |
(2) Once the insulin is totally injected | 44.2 | 31.9 |
(3) Once the insulin is injected and the needle is removed from the skin | 47.3 | 48.0 |
Insulins
Type of Insulin | Percentage of injections in Turkey given with this insulin | Percentage of injections in ROW given with this insulin | Turkey (n) | ROW (n) |
---|---|---|---|---|
Short-acting human R or Regular) | 5.2 | 19.8 | 111 | 2217 |
Rapid-acting analogue | 33.0 | 25.5 | 702 | 2863 |
NPH | 2.9 | 9.4 | 62 | 1055 |
Long-acting analogue | 43.2 | 32.6 | 917 | 3649 |
Pre-mix human or analog | 15.7 | 122.7 | 333 | 1425 |
Total injections | 100.0 | 100.0 | 2125a | 11,209b |
Number of rolls/tips | Turkey (%) (n = 396)a | ROW (%) (n = 2746)a |
---|---|---|
2 | 4.0 | 7.8 |
3 | 4.8 | 7.7 |
4 | 3.8 | 5.7 |
5 | 14.6 | 16.4 |
8 | 4.5 | 3.2 |
10 | 43.7 | 33.2 |
15 | 5.6 | 4.2 |
20 | 13.6 | 9.7 |
Frequency | Turkey (%) (n = 672) | ROW (%) (n = 4230) |
---|---|---|
Often (several times a week) | 14.6 | 7.6 |
Sometimes (several times a month) | 37.1 | 35.7 |
Almost never (several times a year) | 48.4 | 56.7 |
Needlestick Injuries
Who? | Turkey (%) (n = 194) | ROW (%) (n = 1897) |
---|---|---|
Children | 36.1 | 33.2 |
Other family members (e.g. spouse) | 52.6 | 47.4 |
Nurse or other healthcare professional | 3.6 | 5.4 |
House keeper or rubbish collector | 7.7 | 14.0 |
Reason | Turkey (%) (n = 236) | ROW (%) (n = 2448) |
---|---|---|
I don’t use devices that prevent injuries to others (safety devices) | 18.2 | 29.4 |
I don’t have appropriate disposal containers for my used sharps | 55.5 | 40.6 |
Used sharps are sometimes left where others might get stuck | 19.1 | 25.8 |
I’m positive for hepatitis or another blood-borne illness | 7.2 | 4.2 |
Where are sharps disposed? | Turkey (%) (n = 1359) | ROW (%) (n = 11,426) |
---|---|---|
Into a container specially made for used sharps | 7.9 | 22.2 |
Into a home container such as an empty bottle | 13.5 | 24.2 |
Into the rubbish with the cap on | 70.0 | 45.5 |
Into the rubbish without recapping | 5.8 | 7.0 |
I clip off the needle and it stays in the clipper | 2.8 | 1.1 |
What do you do with the waste? | Turkey (%) (n = 589) | ROW (%) (n = 5594) |
---|---|---|
Put it into the rubbish | 61.5 | 38.0 |
Take it to a pharmacist | 0.8 | 14.1 |
Take it to a doctor’s office | 0.5 | 6.9 |
Take it to a laboratory | 0.2 | 0.4 |
Take it to the hospital or clinic | 14.9 | 22.9 |
Take it to a local deposit or collection service | 7.3 | 11.4 |
None of the above | 14.8 | 6.3 |
Discussion
Needle length | Body sites combined | Thigh | Arm | Abdomen | Buttock |
---|---|---|---|---|---|
4 mm | 0.4% | 1.6% | 1.0% | 0.3% | 0.1% |
5 mm | 1.8% | 4.7% | 3.1% | 1.1% | 0.5% |
6 mm | 5.7% |
10.0%
|
7.0%
| 2.8% | 1.3% |
8 mm | 15.3% |
25.0%
|
19.5%
| 9.7% | 5.5% |
12.7 mm | 45.0% | 63.0% | 55.0% | 38.0% | 26.9% |