Grassi Giorgio, Scuntero Paola, Trepiccioni Rosalba, Marubbi Francesca, Strauss Kenneth
S.C.D.U. Endocrinologia, Diabetologia e Metabolismo, A.O. Citta' Della Salute E Della Scienza, Torino, Italy.
C.P.S.E.I. Centro Unificato Diabetologia, A.O. Citta' Della Salute E Della Scienza Torino, Italy.
J Clin Transl Endocrinol. 2014 Jul 23;1(4):145-150. doi: 10.1016/j.jcte.2014.07.006. eCollection 2014 Dec.
The purpose of the study is to assess whether proper Injection Technique (IT) is associated with improved glucose control over a three month period.
Patients ( = 346) with diabetes from 18 ambulatory centers throughout northern Italy who had been injecting insulin ≥ four years answered a questionnaire about their IT. The nurse then examined the patient's injection sites for the presence of lipohypertrophy (LH), followed by an individualized training session in which sub-optimal IT practices highlighted in the questionnaire were addressed. All patients were taught to rotate sites correctly to avoid LH and were begun on 4 mm pen needles to avoid intramuscular (IM) injections. They were instructed not to reuse needles.
Nearly 49% of patients were found to have LH at study entry. After three months, patients had mean reductions in HbA1c of 0.58% (0.50%-0.66%, 95% CI), in fasting blood glucose of 14 mg/dL (10.2-17.8 mg/dL, 95% CI) and in total daily insulin dose of 2.0 IU (1.4-2.5 IU, 95% CI) all with < 0.05. Follow-up questionnaires showed significant numbers of patients recognized the importance of IT and were performing their injections more correctly. The majority found the 4 mm needle convenient and comfortable.
Targeted individualized training in IT, including the switch to a 4 mm needle, is associated with improved glucose control, greater satisfaction with therapy, better and simpler injection practices and possibly lower consumption of insulin after only a three month period.
本研究旨在评估正确的注射技术（IT）是否与三个月期间血糖控制的改善相关。
来自意大利北部18个门诊中心的346例糖尿病患者，他们注射胰岛素≥4年，回答了一份关于其注射技术的问卷。然后护士检查患者的注射部位是否存在脂肪增生（LH），随后进行个性化培训，解决问卷中突出的次优注射技术问题。所有患者都被教导正确轮换注射部位以避免脂肪增生，并开始使用4毫米的笔式针头以避免肌肉注射。他们被指示不要重复使用针头。
在研究开始时，近49%的患者被发现有脂肪增生。三个月后，患者的糖化血红蛋白平均降低0.58%（0.50%-0.66%，95%置信区间），空腹血糖降低14毫克/分升（10.2-17.8毫克/分升，95%置信区间），每日胰岛素总剂量降低2.0国际单位（1.4-2.5国际单位，95%置信区间），所有P<0.05。随访问卷显示，大量患者认识到注射技术的重要性，并更正确地进行注射。大多数人认为4毫米的针头方便且舒适。
仅在三个月后，针对注射技术的有针对性的个性化培训，包括改用4毫米针头，与改善血糖控制、对治疗的更高满意度、更好更简单的注射方法以及可能更低的胰岛素消耗量相关。
