Indian Injection Technique Study: Injecting Complications, Education, and the Health Care Professional

Sanjay Kalra, Ambrish Mithal, Rakesh Sahay, Mathew John, A. G. Unnikrishnan, Banshi Saboo, Sujoy Ghosh, Debmalya Sanyal, Laurence J. Hirsch, Vandita Gupta, Kenneth W. Strauss

Using the Indian and rest of world (ROW) injection technique questionnaire (ITQ) data, we address key insulin injection complications. In 2015 we conducted an ITQ survey throughout India involving 1011 patients. Indian values were compared with those from 41 other countries participating in the ITQ, known here as ROW. More than a quarter of Indian insulin users described lesions consistent with lipohypertrophy (LH) at their injection sites and approximately 1 in 5 were found to have LH by the examining nurse (using visual inspection and palpation). Just over half of Indian injectors report having pain on injection. Of these, 4 out of 5 report having painful injections only several times a month or year (i.e., not with every injection). Doctors and diabetes educators in India (as opposed to nurses) have a larger role in teaching patients how to inject than they do in ROW. Despite this specialized approach, a very high percentage of patients report that they have not been trained (at least cannot remember being trained) in a wide range of essential injection topics. Only about 30% of Indian injectors get their sites checked at least annually, with nearly a third only having sites checked when they specifically complained and nearly 4 out of 10 never having had their sites checked. Indian HCPs can clearly do a better job covering all the vital topics essential to proper injection habits.