title: Insulin pen injection technique survey in patients with type 2 diabetes in mainland China in 2010.
abstract: OBJECTIVE
  The efficacy of injection therapy in diabetes depends on correct injection technique. To provide patients with guidance in this area and help patients inject themselves correctly, we must understand how they currently inject; therefore, the purpose of this study was to assess the current situation of insulin injection technique in patients with diabetes in mainland China.
  
  
  METHODS
  From October 2010 to November 2010, a cross-sectional survey of 380 diabetes patients from 20 centers in mainland China was conducted regarding their daily insulin pen injection practice.
  
  
  RESULTS
  Overall, 35.26% of patients had lipohypertrophy; 58.68% of patients had bleeding and bruising, and abdominal lipohypertrophy at injection sites. Bleeding and bruising were more frequent. We found a significant relationship between the frequency of a single needle reuse and lipohypertrophy (r = 0.426, P = 0.000). In addition, there was a significant relationship between the frequency of daily insulin injection and lipohypertrophy (r = 0.146, P = 0.004), between rolling the pen while pulling out the needle after injection and lipohypertrophy (χ(2 )= 7.355, P = 0.007). Bleeding and bruising at injection sites were found to be related to HbA1c levels (r = 0.151, P = 0.003).
  
  
  CONCLUSIONS
  A few limitations linked with this survey should be noted. Because of the limited budget, the ultrasound was not used to evaluate lipodystrophy and the photographs of lipodystrophy were not taken. On the other hand, specific size of lipodystrophy and the cost of insulin wastage were not evaluated. Furthermore, the population of this survey is limited, and it was only done in general hospitals and not in community hospitals, therefore, a larger study sample is advisable.
  
  
  CONCLUSIONS
  The insulin injection skill of patients with diabetes in mainland China was poor, and the incidence of lipohypertrophy, bleeding, and needle reuse was high. Frequency of daily insulin injection and needle reuse may relate to the incidence of lipohypertrophy and bleeding. The bleeding and bruising at the injection sites may be associated with suboptimal absorption of injected insulin. Improved education in optimal insulin injection technique, including reducing needle reuse and correct rotation of injection sites should be emphasized.
authors.affiliation: Nanjing University of Chinese Medicine , Nanjing , PR China.
authors.forename: Jiajia
authors.initials: J
authors.lastname: Ji
authors.forename: Qingqing
authors.initials: Q
authors.lastname: Lou
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007271:Injections, Intradermal / Q000009:adverse effects / Q000295:instrumentation; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008060:Lipodystrophy; D008297:Male; D008875:Middle Aged
chemical_list: D007328:Insulin
keywords: Diabetes; Injection; Insulin; Lipohypertrophy