Manash P BaruahApollo Excelcare Hospital, India
Title: Insulin injection practices amongst T2DM patients from India
Substantial numbers of poorly controlled type 2 diabetes mellitus (T2DM) patients require insulin. However, insulin injection practices and usage vary widely. We did this cross-sectional retrospective registry study in an urban referral clinic in North East India including 1454 T2DM patients (60% male and 40% female) on insulin therapy, whose insulin utilization pattern and injection techniques were audited. The mean duration of T2DM was 12.13 (7.45) years at enrolment.While 47.73% were treated with insulin alone, 52.27% received other oral antidiabetic drugs(OAD) along with insulin. Majority (62.93%) used Pen device for insulin administration was used by majority(62.93%). The patient-reported main reasons for insulin therapy initiation were OAD failure (33.15%), glucotoxicity (30.26%) and diabetes associated complications (20.36%), as reported by patients. About 2/3rd had HbA1c > 8%. Mean±SD total daily dose of insulin was 33.05±17.09units (0.53 ±0.30units/kg/ day). Majority (67.88%)used premixed insulin, while smaller basal insulin users were in much smaller numbers(10.90%). With regard to injection practices, patients with lipohypertrophy were less likely to rotate the site of injection (0.85 vs. 17.90%; p = 0.000), space the injections (10.71 vs. 23.91%; p = 0.000), injected less often in right site (7.81 vs. 29.0%; p = 0.000), more likely to use wrong angles (10.08 vs. 22.73%; p = 0.000) and reuse the needles (5.63 vs. 14.86%; p = 0.000). 8.87% of patients had experienced at least one episode of hypoglycemic event during preceding 6 moths . This audit reflects the current injection practices amongst T2 DM patients, highlights the faulty ones, suggests the benefits of adopting correct practices for avoiding complications such as lipohypertrophy and hypoglycemia.
Manash P Baruah is currently the Promoter director, HOD, Department of endocrinology,Apollo Excelcare hospital, Guwahati, India. He has >200 publications ( originals, reviews, editorials, abstracts), >5,000 citations and 25 consensus/ clinical practice guidelines. He has also delivered >400 lecture in various international and national forums. He has served in the editorial boards and reviewer panels of various reputed indexed journals. He has been actively involved in clinical research and has served/is serving as Principal investigator/National Advisor for studies such as LEADER(Liraglutide CVOT phase3b), ARISE(IDegAsp phase 4), DUAL(IDegLira phase 3), SOUL( Oral Semaglutide CVOT phase 3b), Combine2( IcoDegSema phase 3).