title: Indian Injection Technique Study: Population Characteristics and Injection Practices.
abstract: BACKGROUND
  It was estimated that 3.2 million Indians with diabetes injected insulin in 2010, but little is known about the techniques used.
  
  
  METHODS
  In 2015 we conducted an injection technique questionnaire (ITQ) survey throughout India involving 1011 patients. Indian values were compared with those from 41 other countries participating in the ITQ, known here as rest of world (ROW).
  
  
  RESULTS
  Mean HbA1c was 8.6. BMI values in India were 1.5-3 units lower than in ROW depending on patient group, meaning the risk of intramuscular (IM) injections is high in India. The mean total daily dose (TDD) of insulin was lower in every category of Indian patient than in ROW, perhaps reflecting the lower BMI. Needle reuse, whether with pens or syringes, is much higher in India than ROW and so is the number of times the needle is used. The majority (56.8%) of Indian insulin users performed only 2 injections/day as opposed to ROW where 45% of patients performed at least 4 injections/day. Indian patients inject insulin in the thighs more often than patients in ROW, a site where IM injections are more risky. Many patients do not have proper access to sharps containers or have other risk factors that could lead to blood-borne pathogen spread. More than 60% of used sharps in India go into the rubbish, with nearly 12% not even having the minimum protection of a cap.
  
  
  CONCLUSIONS
  The shortest needles are very common in India; however, the level of needle reuse is high. Multiple daily injections therapy is not as common in India as ROW. More focus needs to be given to dwell times under the skin, reconstitution of cloudy insulins, skinfolds, and safe sharps disposal.
authors.affiliation: Bharti Hospital, Kunjpura Road, Karnal, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kalra
authors.affiliation: Medanta the Medicity, CH Baktawar Singh Road, Sector 38, Gurgaon, Haryana, India.
authors.forename: Ambrish
authors.initials: A
authors.lastname: Mithal
authors.affiliation: Osmania Medical College, Turrebaz Khan Rd, Esamiya Bazaar, Koti, Hyderabad, Telangana, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sahay
authors.affiliation: Providence Endocrine & Diabetes Specialty Centre, TC 1/2138, Near GG Hospital, Murinjapalam, Thiruvanthapuram, Kerala, India.
authors.forename: Mathew
authors.initials: M
authors.lastname: John
authors.affiliation: Chellaram Diabetes Institute, Pune-Bangalore, NH4, Bavdhan, Pune, Maharashtra, India.
authors.forename: A G
authors.initials: AG
authors.lastname: Unnikrishnan
authors.affiliation: Diacare-Diabetes Care & Hormone Clinic, 1 & 2 Gandhi Park Society, Nehrunagar Cross Roads, Ambavadi, Ahmedabad, Gujarat, India.
authors.forename: Banshi
authors.initials: B
authors.lastname: Saboo
authors.affiliation: AMRI Medical Centre Kolkata, No. 97 A, Southern Avenue, Above Maruti Showroom, Opposite Lake Stadium, Kolkata, West Bengal, India.
authors.forename: Sujoy
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: KPC Medical College and Hospital, Raja Subodh Chandra Mullick Road, Jadavpur, Near Jadavpur Railway Station, Kolkata, West Bengal, India.
authors.forename: Debmalya
authors.initials: D
authors.lastname: Sanyal
authors.affiliation: BD Diabetes Care, 1 Becton Dr. MC 378, Franklin Lakes, New Jersey, USA.
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: Hirsch
authors.affiliation: BD Diabetes Care, BD, 6th Floor Signature Tower-B, South City I, NH 8, Gurgaon, Haryana, India.
authors.forename: Vandita
authors.initials: V
authors.lastname: Gupta
authors.affiliation: BD Diabetes Care, POB 13, Erembodegem-Dorp 86, 9320, Erembodegem, Belgium. kenneth.strauss@bd.com.
authors.forename: Kenneth W
authors.identifier: http://orcid.org/0000-0002-1031-0067
authors.initials: KW
authors.lastname: Strauss
keywords: Infusions; Injections; Insulin; Lipodystrophy; Lipohypertrophy; Needles; Needlestick; Subcutaneous