ABSTRACT
The first Injection Technique workshop brought together endocrinologists and injection experts from around the world in Strasbourg in 1997. From its work came groundbreaking recommendations which advanced best practices in areas such as the use of a skin fold when injecting. The second Injection Technique workshop, with an expanded format including nurses and diabetes educators, took place in Barcelona in 2000. The initial stimulus to use shorter injecting needles can be said to date from this meeting. The third Injection Technique workshop was held in Athens in September 2009 and involved 127 experts from across the globe. After a comprehensive review of all publications since 2000 as well as several unpublished studies, the attendees divided into smaller groups to debate and draft new injecting recommendations based on the new data and their collective experience. This paper summarizes all the formal presentations given at this practical consensus workshop.
Subject(s)
Diabetes Mellitus/drug therapy , Hypoglycemic Agents/administration & dosage , Injections, Subcutaneous , Insulin/administration & dosage , Needles , Subcutaneous Fat, Abdominal , Blood Glucose/metabolism , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Diabetes Mellitus, Type 1/drug therapy , Drug Storage , Equipment Design , Europe/epidemiology , Evidence-Based Medicine , Expert Testimony , Female , Humans , Hypertrophy/etiology , Hypertrophy/prevention & control , Injections, Subcutaneous/adverse effects , Injections, Subcutaneous/instrumentation , Injections, Subcutaneous/methods , Injections, Subcutaneous/psychology , Insulin/analogs & derivatives , Insulin Glargine , Insulin Infusion Systems/trends , Insulin, Long-Acting , Male , Needlestick Injuries/etiology , Needlestick Injuries/prevention & control , Patient Education as Topic , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications/prevention & control , Subcutaneous Fat, Abdominal/injuries , Subcutaneous Fat, Abdominal/pathology , Syringes , United Kingdom , United StatesABSTRACT
AIM: Injections administered by patients are one of the mainstays of diabetes management. Proper injection technique is vital to avoiding intramuscular injections, ensuring appropriate delivery to the subcutaneous tissues and avoiding common complications such as lipohypertrophy. Yet few formal guidelines have been published summarizing all that is known about best practice. We propose new injection guidelines which are thoroughly evidence-based, written and vetted by a large group of international injection experts. METHODS: A systematic literature study was conducted for all peer-reviewed studies and publications which bear on injections in diabetes. An international group of experts met regularly over a two-year period to review this literature and draft the recommendations. These were then presented for review and revision to 127 experts from 27 countries at the TITAN workshop in September, 2009. RESULTS: Of 292 articles reviewed, 157 were found to meet the criteria of relevance to the recommendations. Each recommendation was graded by the weight it should have in daily practice and by its degree of support in the medical literature. The topics covered include The Role of the Professional, Psychological Challenges, Education, Site Care, Storage, Suspension and Priming, Injecting Process, Proper Use of Pens and Syringes, Insulin analogues, Human and Pre-mixed Insulins, GLP-1 analogs, Needle Length, Skin Folds, Lipohypertrophy, Rotation, Bleeding and Bruising, Pregnancy, Safety and Disposal. CONCLUSION: These injecting recommendations provide practical guidance and fill an important gap in diabetes management. If followed, they should help ensure comfortable, effective and largely complication-free injections.
