Kamrul-Hasan Abm, Paul Ajit Kumar, Amin Mohammad Nurul, Gaffar Md Abu Jar, Asaduzzaman Md, Saifuddin Mohammad, Mustari Marufa, Alam Md Jahangir, Shahid Mohammad Moin, Nahid-Ul-Haque K M, Alam Muhammad Shah, Rahman Md Motiur, Talukder Samir Kumar, Kader Md Abdul, Akter Farhana, Hannan Mohammad Abdul, Chanda Palash Kumar, Bakar Muhammed Abu, Selim Shahjada
Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh.
Department of Endocrinology, Mainamoti Medical College, Cumilla, Bangladesh.
Eur Endocrinol. 2020 Apr;16(1):41-48. doi: 10.17925/EE.2020.16.1.41. Epub 2020 Feb 28.
Diabetes mellitus is highly prevalent in Bangladesh and insulin is often needed for diabetes control. We lack sufficient data on the insulin injection technique and injection-related complications.
The Bangladesh Insulin Injection Technique Survey (BIITS) was conducted in 2018 in 18 centres throughout Bangladesh, involving 847 patients taking insulin for at least 6 months. All of the study subjects were interviewed using a structured questionnaire focusing on key insulin injection parameters.
The mean duration of insulin use by the study subjects was 3.84 (± 4.05) years and the mean daily dose of insulin was 41 (± 25) units. A total of 71.6% participants performed ≤2 injections/day and premixed insulins were the most commonly used insulins. Mean glycated haemoglobin (HbA1c) was 9.5% (± 2%). The proportion of syringe users and pen-device users was 68.1% and 31.9%, respectively. Most of the participants injected in the abdomen and rotated the injection site(s). The majority lifted the skinfold correctly and inserted the needle at a 90-degree angle, but their dwell times after injections were not adequate. A total of 9.2% of the subjects had injection-site lipohypertrophy (LH) and among them, 38.5% injected into the lesion. Patients with LH had higher HbA1c. Higher duration of insulin use (≥5 years), reusing needles more often (>10 times), and injecting at angles other than 90 degrees were independent predictors of LH. The incidences of hypoglycaemia (36.7%) and hyperglycaemia (67.4%) were very high, and subjects with LH had higher chances of both hypoglycaemia and hyperglycaemia. Though most (92.1%) of the patients received education about insulin injection initially, it was not repeated in the recent follow-up and was found to be ineffective.
A huge gap between the insulin administration guidelines and current practice was observed in this study. Complications of insulin injections were also common. Healthcare providers should pay more attention to insulin education and re-evaluate injection practices from time to time.
糖尿病在孟加拉国极为普遍，控制糖尿病常常需要使用胰岛素。我们缺乏关于胰岛素注射技术及注射相关并发症的充分数据。
2018年在孟加拉国各地的18个中心开展了孟加拉国胰岛素注射技术调查（BIITS），涉及847名使用胰岛素至少6个月的患者。所有研究对象均通过一份聚焦关键胰岛素注射参数的结构化问卷进行访谈。
研究对象使用胰岛素的平均时长为3.84（±4.05）年，胰岛素平均日剂量为41（±25）单位。共有71.6%的参与者每天注射次数≤2次，预混胰岛素是最常用的胰岛素。糖化血红蛋白（HbA1c）的平均值为9.5%（±2%）。使用注射器的用户和使用笔式装置的用户比例分别为68.1%和31.9%。大多数参与者在腹部注射并轮换注射部位。大多数人正确提起皮肤褶皱并以90度角进针，但注射后的停留时间不足。共有9.2% 的受试者出现注射部位脂肪增生（LH），其中38.5% 在病变部位注射。患有LH的患者HbA1c水平更高。胰岛素使用时间较长（≥5年）、更频繁地重复使用针头（>10次）以及非90度角注射是LH的独立预测因素。低血糖（36.7%）和高血糖（67.4%）的发生率非常高，患有LH的受试者发生低血糖和高血糖的几率更高。尽管大多数（92.1%）患者最初接受了胰岛素注射教育，但在最近的随访中未重复进行，且发现效果不佳。
本研究发现胰岛素给药指南与当前实践之间存在巨大差距。胰岛素注射并发症也很常见。医疗保健提供者应更加重视胰岛素教育，并定期重新评估注射操作。
