An Important part of pharmaceutical care is to ensure patient compliance to establish better health outcomes, Poor diabetes management can result in elevated risks of complications of uncontrolled diabetes. Studies like DCCT have shown adherence to insulin therapy among patients have provided significant reduction in diabetes complications.s Despite all different available insulin delivery systems, Insulin injections are still a big obstacle to patient’s adherence to controlled therapy. Recent advances in injection technique have the potential to help improve patient adherence to insulin therapy in diabetic patients.
In most communities around the world, injections are still the most common delivery route for insulin. This route of administration has resulted in lack of adherence to therapy due to fear of needles and injections. Many of type II Diabetics who are in actual need of insulin therapy try to postpone it because of that needle fear.
Injectable therapy devices have evolved significantly from using detachable needle of a reusable glass syringes to single-use, sterilized plastic syringes. Insulin pen delivery system was the great leap in insulin therapy, which provided less painful more convenient method to administer the medication. Needle length and diameter have progressively decreased, from 12 mm, to 8 mm, and now 5 mm and 4mm. Needles can be beveled and lubricated for ease of injection with improved comfort.
Insulin is administered subcutaneously this means that a proper injection technique should not reach the muscular area. Injection sites can vary from the upper arm, upper thigh, abdomen, and buttocks. Injection technique includes a wide range of variables such as site of injection, needle length, angle of needle insertion, and use of lifted skin fold.
Skin thickness is an important factor in choosing needle length, Injection site affects skin thickness, where the thinnest skin and subcutaneous tissue layers are in the thigh and the thickest skin and subcutaneous tissue layers are in the buttocks. Accordingly, shorter-length (4-mm and 5-mm) needles may be successfully used to administer insulin at almost all sites in nearly all adults with diabetes. Moreover, shorter needles reduce the risk of the needle reaching the muscle area. Studies show that a 90° angle injection using 4-mm needles without raising a skin fold delivers insulin into the subcutaneous space over 99.5% of the time.
Pharmacists can play a key role in educating health care providers and patients who may be unaware of the the newer injection devices and technique, Improper use of the use these devices or technique may result in unnecessary pain or change in insulin absorption pattern due to possible intramascular absorption. No all patients are aware of the newer choices including shorter and thinner needles. Pharmacists are in a unique position to provide the right advice especially to new patients or those who are still using older devices and techniques. With available devices, Patients need to be assured that needle fear is no longer justified and it can provide more controlled diabetes management.
As a result , The right combination of selecting the proper device and appropriate technique can significantly decrease the pain associated with injections, and therefore may help in establishing better patient adherence.