title: Improvement of glycemic control by re-education in insulin injection technique in patients with diabetes mellitus.
abstract: BACKGROUND
  The aim of this study was to evaluate the effectiveness of re-education in the insulin injection technique for glycemic control.
  
  
  METHODS
  A preliminary experimental study was performed with 87 insulin-treated diabetic outpatients (11 with type 1 diabetes, 76 with type 2 diabetes; 43 men, 44 women). All patients had been treated with insulin for more than 3 years. After answering questions about the insulin injection technique, the patients' knowledge levels were scored. Correct answers and explanation sheets were subsequently given to all patients. The physicians in charge gave a short lecture and provided 10 min of individual advice. Two, three, and four months after re-education the HbA1c and glycoalbumin levels were measured.
  
  
  RESULTS
  The mean HbA1c levels of almost all patients significantly improved from 7.46 ± 0.09% to 6.73 ± 0.10% (P < 0.01), and the mean glycoalbumin levels significantly improved from 22.76 ± 0.50% to 20.26 ± 0.68% (P < 0.01). Twenty-five patients demonstrated a poor understanding (score of ≤6 points) and showed a significant decrease in the HbA1c level from 7.62 ± 0.20% to 6.71 ± 0.21% (P = 0.02). Forty-three patients demonstrated a moderate understanding (score of 7 or 8 points) and showed a decrease in the HbA1c level from 7.40 ± 0.13% to 6.68 ± 0.07% (P = 0.07). Finally, 19 patients demonstrated a good understanding (score of ≥9 points) and showed a slight decrease in the HbA1c level from 7.38 ± 0.15% to 6.93 ± 0.12% (P = 0.09). Patients with a poor understanding showed the largest decrease in the mean level of HbA1c.
  
  
  CONCLUSIONS
  Re-education in the insulin injection technique led to an improvement in glycemic control in insulin-treated diabetic patients, especially in those with a poor understanding of the insulin injection technique. More attention should be paid to these strategies for outpatients.
authors.affiliation: Department of Diabetes and Endocrinology, Dokkyo Medical University Nikko Medical Center, Tochigi, 321-2593, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakatani
authors.forename: Mihoko
authors.initials: M
authors.lastname: Matsumura
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Monden
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Aso
authors.forename: Takaaki
authors.initials: T
authors.lastname: Nakamoto
mesh_terms: D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous / Q000379:methods; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012648:Self Care / Q000379:methods*; D012709:Serum Albumin; D016896:Treatment Outcome; D000093423:Glycated Serum Albumin
chemical_list: D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D007004:Hypoglycemic Agents; D007328:Insulin; D012709:Serum Albumin; D000093423:Glycated Serum Albumin; C517652:hemoglobin A1c protein, human