Indwelling catheters used from the onset of diabetes decrease injection pain and pre-injection anxiety.
OBJECTIVE
To investigate the use of indwelling catheters as injection aids at diabetes onset to reduce injection pain and pre-injection anxiety.


METHODS
Forty-one patients aged 8.1 +/- 3.7 years (range, 1-15) participated in this open, controlled randomized study. A 10-cm VAS with faces was used for scoring. A local anesthetic cream was used before all insertions. The control group used insulin pens with standard needles. After one week, the indwelling catheter group could choose regular injections but were included in the "intention to treat" analysis.


RESULTS
Injection pain and anxiety decreased from day 1 to 15 in both groups (average, 4.1 injections/day). Pain was significantly lower for indwelling catheter injections when scored by parents (median, 1.2 cm vs 2.7 cm; P =.002), children/teenagers (0.8 cm vs 1.5 cm; P =.006), and nurses (1.4 cm vs 3.0 cm; P =.002). Parental pre-injection anxiety was also lower (1.2 cm vs 2.9 cm; P =.016). Taking injections, including inserting catheters, was found to be less problematic with an indwelling catheter (1.6 cm vs 3.3 cm;P =.009). During the 6-month follow-up, injection pain and injection problems were significantly lower in the catheter group. Mean catheter indwelling time was 3.7 days. Median pain for catheter insertion was 2.1 cm and for glucose testing was 0.9 cm. Sixteen of 20 patients continued to use indwelling catheters after 2 weeks, and 9 of 20 after 6 months.


CONCLUSIONS
We found an evident relief of pre-injection anxiety and injection pain when using indwelling catheters for introducing insulin injections at the onset of diabetes.
Hanas
Ragnar
R
Department of Pediatrics, Uddevalla Hospital, Uddevalla, Sweden. ragnar.hanas@bll.se
Adolfsson
Peter
P
Elfvin-Akesson
Karin
K
Hammarén
Lars
L
Ilvered
Rosita
R
Jansson
Inger
I
Johansson
Calle
C
Kroon
Marianne
M
Lindgren
Jan
J
Lindh
Agne
A
Ludvigsson
Johnny
J
Sigström
Lars
L
Wiik
Annica
A
Aman
Jan
J
Jansson
Iner
I
Wilk
Annica
A
D000293:Adolescent; D017668:Age of Onset; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007223:Infant; D007279:Injections, Subcutaneous / Q000009:adverse effects* / Q000523:psychology; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010290:Parents / Q000523:psychology; D010353:Patient Education as Topic; D013997:Time Factors
D007328:Insulin