Helping to achieve HbA1c targets

GRASSI 2014¹: Optimizing insulin injection technique improves glucose control in only three months

This study shows that the combined intervention of injection technique and injection site assessment by trained HCP followed by general and individualised injection technique education, the avoidance of injections into lipohypertrophy and the use of correct rotation along with switch to 4mm pen needles led to significant clinical improvements.

Other observations at 3 months:

• Lipohypertrophic lesions unchanged
• Patients using more optimal injection technique (Range of IT Practice parameters p<0.05)
• Most patients stopped using pinch-up when using 4mm PN
• Significant shift to longer ‘in-dwell’ times (i.e. more patients keeping in skin for full 10 sec)
• Proper injection technique was rated as very important by significantly higher percentage than at initiation (40.1% at entry – 64.6% at 3/12 +24.5 p<0.05)
• Majority of patients indicated high levels of satisfaction with BD Micro-Fine™ 4mm PN (88.9% very happy with 4mm PN at 3/12
• Needle reuse not common at start and not significantly changes at end of study

Benefits of lowering HbA1c

Epidemiological analysis of the UK Prospective Diabetes Study (UKPDS 1998)² data showed that for every 1% reduction in HbA1c, the relative risk for:

• Microvascular complications decreased by 37%^2,3
• Diabetes-related deaths 21%^2,3
• Myocardial infarction 14%^2,3

Two large-scale studies - the UK Prospective Diabetes Study (UKPDS 1998)² and the Diabetes Control and Complications Trial (DCCT 1993)⁴ - demonstrated that improving HbA1c by 1% (or 11 mmol/mol) for people with type 1 diabetes or type 2 diabetes cuts the risk of combined microvascular complications by 25%

Research has also shown that people with type 2 diabetes who reduce their HbA1c level by 1% are²:

• 19% less likely to suffer cataracts
• 16% less likely to suffer heart failure
• 43% less likely to suffer amputation or death due to peripheral vascular disease

References

• ¹ Grassi G, Scuntero P, Trepiccioni R, Marubbi F, Strayss K. Optimizing insulin injection technique and its effect on blood glucose control. Journal of Clinical Translational Endocrinology. 2014;148:145–50
• ² United Kingdom Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837–853, 1998
• ³ Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321:405–412, 2000
• ⁴ Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New Engl J Med 329:977–986, 199