Assessment of self-reported insulin injection techniques among patients with Diabetes Mellitus on follow-up at adult Endocrine clinic at Tikur Anbessa Specialized Hospital: Hospital-based cross-sectional study September 1 - October 31, 2020 G.C.

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Addis Abeba University


Background Assessment of injection device use and injection technique, are key components of a comprehensive diabetes medical evaluation and treatment plan. Proper insulin injection technique may lead to more effective use of this therapy and, as such, holds the potential for improved clinica l outcomes. The lack of a clear number of patients with diabetes mellitus requiring insulin therapy, and few studies focused on either assessing injection techniques or associated complicat ions separately have indicated suboptimal knowledge and skill with higher than the worldwide average on the presence of complications. Objective Major insulin injection parameters were assessed among patients with diabetes mellitus on followup at the adult diabetes referral clinic in TASH, Addis Ababa from September 1 to October 31, 2020. Methods A cross-sectional survey was conducted from September 1 to October 31, 2020, at the diabetes clinic in Tikur Anbessa Specialized Hospital. Data were collected by using a structured, interviewer-administered questionnaire. Then, entered and analyzed using SPSS version 20. To identify factors associated with injection techniques, bivariable and multivariable binary logist ic regression analyses were done. Statistical significance was considered at a level of significance of 5%, and adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to present the estimates of the strength of the association Results A total of 293 participants were included in this study. The most common type of diabetes reported was Type 2 diabetes mellitus. From the recommended injection sites, 256 (87.4%) inject at more than 1 site with the thigh (249/85%) being the most often used site. The median total daily insulin dose was 54IU. Insulin syringe reuse was practiced by practically all (98%) of the participants. Injection site rotation is practiced by 272 (92.8%) of the participants. The presence of anyswellings or lumps over the injection sites was reported by 113 (38.6%) of the participants with the thigh being the most common site. Disposal of used syringes capped into the trash is the practice of 176 (60.1%) of the study participants. From the multivariate analysis, sex (AOR=2.33, 95% CI:1.13-4.83), total daily dose of insulin (AOR=0.99, 95% CI:0.98-0.99), last time injection instructions were reviewed (AOR=0.35, 95% CI:0.13-0.97) and hyperglycemia events (AOR=0.56, 95% CI:0.31-0.99) showed significant association with the presence of lipohypertrophy. Conclusion: This study revealed that there are alarmingly high rates of injection-related complications. The diabetes education given pertaining to injection parameters and evaluation of injection sites are neglected which will fuel the occurrence of complications. It highlights the need for the provision of patient-centered instruction and education about insulin injection techniques.



Diabetes mellitus, insulin, insulin injection technique, lipohypertrophy, cross-sectional study