Improvement of Glycemic Control by Re-education in Insulin Injection Technique in Patients with Diabetes Mellitus

The aim of this study was to evaluate the effectiveness of re-education in the insulin injection technique for glycemic control. A preliminary experimental study was performed with 87 insulin-treated diabetic outpatients (11 with type 1 diabetes, 76 with type 2 diabetes; 43 men, 44 women). All patients had been treated with insulin for more than 3 years. After answering questions about the insulin injection technique, the patients' knowledge levels were scored. Correct answers and explanation sheets were subsequently given to all patients. The physicians in charge gave a short lecture and provided 10 min of individual advice. Two, three, and four months after re-education the HbA(1c) and glycoalbumin levels were measured. The mean HbA(1c) levels of almost all patients significantly improved from 7.46 +/- A 0.09% to 6.73 +/- A 0.10% (P < 0.01), and the mean glycoalbumin levels significantly improved from 22.76 +/- A 0.50% to 20.26 +/- A 0.68% (P < 0.01). Twenty-five patients demonstrated a poor understanding (score of a parts per thousand currency sign6 points) and showed a significant decrease in the HbA(1c) level from 7.62 +/- A 0.20% to 6.71 +/- A 0.21% (P = 0.02). Forty-three patients demonstrated a moderate understanding (score of 7 or 8 points) and showed a decrease in the HbA(1c) level from 7.40 +/- A 0.13% to 6.68 +/- A 0.07% (P = 0.07). Finally, 19 patients demonstrated a good understanding (score of a parts per thousand yen9 points) and showed a slight decrease in the HbA(1c) level from 7.38 +/- A 0.15% to 6.93 +/- A 0.12% (P = 0.09). Patients with a poor understanding showed the largest decrease in the mean level of HbA(1c). Re-education in the insulin injection technique led to an improvement in glycemic control in insulin-treated diabetic patients, especially in those with a poor understanding of the insulin injection technique. More attention should be paid to these strategies for outpatients.