CHICAGO — Many patients with diabetes probably could benefit from a refresher course in how to inject insulin properly, according to a report presented at the annual scientific sessions of the American Diabetes Association.
In a trial of an education program for diabetes patients, 87 adult patients who had been using insulin for at least 3 years were evaluated and then retaught how to inject, based on what they did not seem to know. The mean hemoglobin A1c (HbA1c) level in the group dropped from 6.94% at baseline to 6.28% at 4 months after the new training.
The trial showed that more than half of these highly experienced patients had a “poor” or only “moderate” understanding of how best to treat their insulin and give themselves their injections, said Dr. Mihoko Matsumura, of the department of endocrinology and metabolism at Dokkyo University, Tochigi, Japan.
At the beginning of the trial, patients were given a detailed test of their knowledge. They were asked more than 20 questions, including:
▸ How they stored their insulin.
▸ At what temperature they stored it.
▸ What type of needle they used.
▸ Whether they were satisfied with the type of needle they were using.
▸ If they reused needles.
▸ If they knew the principle of how deep they should be injecting.
▸ Whether they pinched-up the skin and fat to avoid intramuscular injection.
▸ What angle of the needle they used when injecting.
▸ Whether they used the same injection site repeatedly.
The test results were then scored and grouped according to whether the patients had poor, moderate, or good understanding. After the test, all patients were given an explanation sheet, which included the correct answers. They also received a 10-minute review of their test with a physician.
Only 28 of the 87 patients were found to have “good” understanding on the test, defined as answering more than half the questions correctly. Another 38 had “moderate” understanding, defined as answering about half the questions correctly. And 21 had “poor” understanding, getting fewer than half the answers correct.
One of the most common problems the patients had was that they tended to inject repeatedly in the same location, Dr. Matsumura said.
The patients with the poorest understanding had the most improvement in HbA1c level at 4 months after the test, dropping from a mean of 7.03% before the test to 6.26% after, she noted.