Pediatric Insulin Injection Technique: A Multi-Country Survey and Clinical Practice Implications.

Area of Science:

• Pediatric Endocrinology
• Diabetes Management
• Clinical Nursing

Background:

• A survey of 13,289 patients identified 898 pediatric patients (≤18 years) for analysis.
• Pediatric patients were categorized into three age groups: 0-6 years (G1), 7-13 years (G2), and 14-18 years (G3).

Purpose of the Study:

• To evaluate insulin injection techniques and associated complications in pediatric patients.
• To identify factors contributing to lipohypertrophy, hypoglycemia, and glucose variability in children with diabetes.

Main Methods:

• Utilized data from the 2015 Insulin Injection Technique Questionnaire.
• Assessed injection technique through questionnaires and nurse evaluations across three pediatric age groups.
• Analyzed prevalence of lipohypertrophy, hypoglycemia, glucose variability, needle usage, and injection training.

Main Results:

• High rates of lipohypertrophy (41.3-47.3%) were observed across all pediatric age groups.
• Unexpected hypoglycemia (23.8-48.1%) and glucose variability (45.9-61.0%) were common and linked to lipohypertrophy.
• Inappropriate needle lengths (up to 61.5%), needle reuse (up to 32.5%), and lack of recent injection training (up to 26.8%) were prevalent.

Conclusions:

• Recommend 4-mm pen needles or 6-mm syringes (at 45° angle) for pediatric patients.
• Advise patients ≤6 years to inject into a raised skin fold.
• Emphasize site rotation and single needle use for all patients to prevent lipohypertrophy.