Background and Objective: In the midst of a type 2 diabetes epidemic in China where hemoglobin A1C needs to be better controlled, clinicians strive to examine and work to correct patients’ poor insulin pen injection practices. We explored insulin injection techniques, injection site problems, and A1C.

Methods: In a large cross-sectional study of adult patients with type 2 diabetes (n=455) from 10 medical centers, patients answered an in-depth questionnaire and had their insulin injection technique observed. Researchers assessed for lipohypertrophy (LH) by observing and palpating injection sites. Logistic regression and linear regression were used to examine factors related to presence of LH and A1C.

Results: Mean years taking insulin was 5.20, and 83.30% injected insulin ≥2 times/day. Mean needle reuse was 8.95 times (range 1-59), but was not correlated with LH or A1C. Percent with incorrect site rotation was 22.80% and presence of LH was 11.14%. A1C was 9.03±2.13%. Presence of LH was significantly associated with longer duration of insulin injection (OR=1.10, p=0.01, 95% CI [1.02, 1.17]) and total number of insulin injections/day (OR=2.27, p<0.001, 95% CI [1.49, 3.44]), but not with incorrect site rotation (OR=0.45, p=0.07, 95% CI [0.19, 1.06]). Odds of presence of LH in participants using 5 mm needles were 3.95 times (p=0.01, 95% CI [1.48, 10.54]) that of 4 mm needles. Higher A1C was significantly associated with the presence of LH (ß=0.54, p<0.01, 95% CI [0.20, 0.88]).

Conclusion: Needle reuse is a major problem in Chinese patients with type 2 diabetes, and A1C is poorly controlled. Patients with LH are more likely to have higher A1C. Given the diabetes epidemic in China, immediate measures must be implemented to improve insulin injection techniques and prevent LH for better glycemic control. This study indicated that 4 mm needles may have an advantage over 5 mm needles in regard to the presence of LH, yet further studies are needed to examine this relationship.


F. Li: None. A. Fish: None. U. Tokac: None.

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