Safety of the reuse of needles for subcutaneous insulin injection: A systematic review and meta-analysis.
OBJECTIVE
Many people with diabetes often reuse disposable needles for subcutaneous insulin injection. We aimed to identify, critically appraise and summarize the available evidence about the safety of this practice.


METHODS
Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.


METHODS
MEDLINE (via PubMed), CINALH (via EBSCO), SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials and Open Grey were searched from their inception to December 2015, with no language restrictions.


METHODS
Epidemiologic and experimental studies assessing adverse effects of reusing needles in people of any age or sex, with or without diabetes, were included. Two reviewers independently assessed the methodological quality of included studies using a multi-design tool.


RESULTS
In total, 25 studies were included. All studies had a high risk of bias and data from only nine studies could be pooled. Five studies showed no association between infection at site of injection and reuse of needles (risk difference=-0.00; 95% confidence interval=-0.12-0.11; P=0.99); heterogeneity between these studies was substantial (I(2)=66%; P=0.02). Five cross-sectional studies showed an association between lipohypertrophy and needle reuse (risk difference=0.16, 95% confidence interval=0.05-0.28, P=0.006); there was strong evidence of heterogeneity between these studies (I(2)=87%; P<0.001). Pooled data of two studies with no evidence of heterogeneity between them showed more perceived pain among reusers (risk difference=0.24; 95% confidence interval=0.06-0.43; P=0.006). Reusing a pen needle or disposable syringe-needle was not associated with worse glycaemic control.


CONCLUSIONS
There is currently no clear scientific evidence to suggest for or against the reuse of needles for subcutaneous insulin injection. This practice is very common among people with diabetes; consequently, further research is necessary to establish its safety.
Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Department of Nursing, Universitat de Girona, c/ Emili Grahit 77, 17071 Girona, Spain. Electronic address: ezabaleta@idiapjgol.org.
Edurne
E
Zabaleta-Del-Olmo
Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain. Electronic address: bogdan.vlacho@hotmail.com.
Bogdan
B
Vlacho
Primary Health Care Centre Cornellà 2 (Sant Ildefons), Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Av. República Argentina s/n (cantonada Av. de Sant Ildefons), 08940 Cornellà de Llobregat, Spain. Electronic address: ljodar74@gmail.com.
Lina
L
Jodar-Fernández
Primary Health Care Centre Carles I, Àmbit d'Atenció Primària Barcelona-Ciutat, Institut Català de la Salut, c. de la Marina, 168, 08018 Barcelona, Spain. Electronic address: amurpi.bcn.ics@gencat.cat.
Ana-María
AM
Urpí-Fernández
Emergency Primary Care Centre El Castell, Consorci Castelldefels Agents de Salut (CASAP), c. Guillermo Marconi, 9 bxs, 08860 Castelldefels, Spain. Electronic address: irislumillo@gmail.com.
Iris
I
Lumillo-Gutiérrez
Primary Health Care Centre La Mina, Àmbit d'Atenció Primària Barcelona-Ciutat, Institut Català de la Salut, c. del Mar, s/n, 08930 Sant Adrià de Besòs, Spain. Electronic address: jagudo.bcn.ics@gencat.cat.
Josep
J
Agudo-Ugena
Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain. Electronic address: rmorros@idiapjgol.org.
Rosa
R
Morros-Pedrós
Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain. Electronic address: cviolan@idiapjgol.org.
Concepción
C
Violán
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009339:Needles; D061214:Patient Safety; D055815:Young Adult
D007328:Insulin
Equipment reuse; Insulin; Meta-analysis; Needles; Patient safety; Systematic review