Patient errors in use of injectable antidiabetic medications: A need for improved clinic-based education

This case series was designed to educate and inform health care professionals on the importance of providing adequate education on injectable antidiabetic agents and highlighting common medication errors related to diabetes care seen in ambulatory practice. The discussion following case descriptions will attempt to characterize patients who may be at high risk for these errors and identify ways to reduce the potential for error.

In a diabetes care clinic, 4 cases were identified in which the patient experienced an escalation of insulin or other injectable antidiabetic medication doses with no improvement in glycemic control. Two of the cases involved failure to remove an inner needle cap because of a poor understanding of pen use. One case was attributed to switching formulations without providing proper education for an adult patient with a learning impairment, and the other was attributed to suboptimal absorption of insulin doses from lipohypertrophy. Three of the 4 cases resulted in multiple instances of hypoglycemia, and all 4 patients exhibited markedly improved glycemic control once the injection error was corrected. The clinic pharmacist played an essential role in identifying and correcting administration errors within an interdisciplinary team.

Based on the observations from the 4 cases, clinicians should be prompted to review antidiabetic medication injection techniques before initiation and periodically thereafter with their patients. Factors that should prompt further education include low health literacy, language barrier, initiation of medication by another provider, switch of medication product or formulation, obvious discrepancies between refill history and patient's self-reported adherence, observed lipohypertrophy, and escalation of doses without any improvement in glycemic control. A referral to the clinic pharmacist should be considered to provide more detailed education for these patients.