New Insulin Delivery Recommendations.
Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes.
Department of Endocrinology, Skane University Hospital, Malmö, Sweden.
Anders H
AH
Frid
Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Gillian
G
Kreugel
Città della Salute e della Scienza Torino, Torino, Italy.
Giorgio
G
Grassi
University for Sciences and Medicine Joseph Fourier Grenoble and Diabetology Department CHU Grenoble, Grenoble Cedex, France.
Serge
S
Halimi
Barnet, Enfield & Haringey Mental Health Trust, London, UK.
Debbie
D
Hicks
BD Diabetes Care, Franklin Lakes, NJ.
Laurence J
LJ
Hirsch
BD Medical.
Mike J
MJ
Smith
Private practice, Kassel, Germany.
Regine
R
Wellhoener
Atlanta Diabetes Associates, Atlanta, GA.
Bruce W
BW
Bode
University of Washington Medical Center-Roosevelt, Seattle.
Irl B
IB
Hirsch
Bharti Hospital & B.R.I.D.E., Karnal, India.
Sanjay
S
Kalra
Peking University Peoples Hospital, Beijing, China.
Linong
L
Ji
BD Diabetes Care, Erembodegem, Belgium. Electronic address: kenneth_strauss@europe.bd.com.
Kenneth W
KW
Strauss
D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007267:Injections / Q000592:standards*; D007328:Insulin / Q000008:administration & dosage*; D007558:Italy; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*
D007004:Hypoglycemic Agents; D007328:Insulin