Endocrine Abstracts

Introduction: Allowing to have a good glycemic control, presenting no contraindications and contributing to the optimization of the general and nutritional state, insulin remains a treatment of choice for the diabetic elderly. Proper injection technique is key to achieving and maintaining goal-level diabetes control. The objective of our study was to assess insulin injection techniques in elderly subjects with type 2 diabetes.

Methods: A cross-sectional study on type 2 diabetic insulin dependent elderly recruited from the outpatient endocrinology consultation over a period of 2 months from June 2021 to July 2021.

Results: We recruited 100 patients with a mean age of 70.8±5.8 years and a sex ratio of 0.85. The mean durations of diabetes and insulin therapy were 15.67±6.7 years and 7.69±6 years, respectively. The mean level of HbA1C was 9.85±1.7%. The majority of patients had uncontrolled diabetes (90%). Sixty-seven were on human insulin (67%) and thirty-three patients were on insulin analogues (33%). Pens were the instruments of injection for 33% of patients. The use of long needles of 6- and 8-mm was noted in 68% of patients although 4 mm needles are the recommended safer option. The patients were dependent on a third person to ensure the injection in 24% of cases. Abdomen and Arms were the preferred injection sites (76% and 59%, respectively). No patient used all four injection sites. Vial or cartridge of cloudy insulin was rolled or tipped less than 20 times in 2% and 3%, respectively. Extensive pen needle re-use (10+ times) for 29% of the patients exposed them to both higher intramuscular (IM) injection risk and lipohypertrophy (LH). Pain or Injection site bleeding was reported by 67% and 54% of patients, respectively. Nearly half of elderly diabetics (47%) skipped injections. In one-third of cases, patients had a history of severe hypoglycemia (35%).

Conclusion: According to our results, almost all aspects of insulin injection need to be improved in diabetic elderly subjects. This requires increased surveillance of the elderly, who face greater challenges in the feasibility of adequate injections.