Insulin injection techniques intervention effect on Glycemic control among adult diabetic patients attend At ambulatory clinic of jimma medical center, southwest Ethiopia: interventional study

Abstract

Background: Insulin therapy is the mainstay of treatment for type I diabetes and adjunct therapy for some type II diabetic patients. Proper storage and self-administration of insulin play an important role on good blood glucose control. There is scant published literature on insulin injectio techniques intervention effect on the overall glycemic control in the study area. Objective: To evaluate insulin injection techniques intervention effect on glycemic control among adult diabetic patients attend at ambulatory clinic of jimma medical center, southwest Ethiopia. Methods: A pre-post interventional study was conducted at Jimma medical center, Jimma, Ethiopia from January to May 2022. A structured questionnaire was used to assess patient socio- demography; baseline injection technique and storage were assessed using a standard check-list of recommended steps adopted from the American diabetic association guideline. At visit 2, glycemic control and injection techniques were re-evaluated. Independent predictors of outcome were identified and the strength of association between dependent and independent variables was determined by using binary and multiple logistic regression analysis. Statistical significance was considered at p <0.05. McNemar and Wilcoxon rank tests were used to compare pre-post injection technique and glycemic control results, respectively, and the Wilcoxon rank test was also used to compare total daily dose. Result: A total of 280 patients were included in the analysis. The number of male participant showed preponderance 163 (58.2%). More than half of the participants 144 (51.4%) were type one DM patients. The mean age of the participant was 42.7±15 with range of 19-85 years. The most frequent missed step at baseline were rotate and record rotation of injection site where 190 (67.9%), and afer intervention was injecting air into the vial at the oblique angle 111 (39.6%). The overall performance correct injection technique was 26.4% before intervention and 46.4% after intervention. The prevalence of lipohypertrophy, pain, bleeding or bruising and insulin leakage were 49.4%, 36.8%, 28.6% and 25% respectively. The independent predictors of poor glycemic control are overall performance injection technique with (p=0.0001),(AOR:17.295;95%CI:[7.392,40.466]), BMI those with overweight(BMI=25.0–29.9 kg/m 2 )(p=0.005),(AOR:2.997;95%CI:[1.388,7.282]) and obese (BMI=≥30.0 kg/m 2 )(p=0.001), (AOR:10.913;95%CI:[2.566,46.399]), lipohypertrophy with (p=0.034), (AOR:2.182;95%CI:[1.061,4.488]), insulin leakage (p=0.027), (AOR:2.609;95%CI:[1.114,6.11]) and age between 35- 65 years (p=0.031), (AOR:0.4;95%CI:[0.174,0.922]). Conclusion: The finding of this study was revealed that the overall performance of correct injection technique was significantly improved from baseline to post-intervention. The prevalence of injection site complication such as LH, pain, bruising and insulin leakage was high in the present study. Less than one-third of patients developed hypoglycemia and hypoglycemic episode. Health professionals should deliver methods through verbal instructions, written instructions and physical demonstration. Before increasing dose of insulin in patients with poorly controlled diabetes, it’s better to evaluate patient performance of injection and storage technique.