Elsevier

Mayo Clinic Proceedings

Volume 91, Issue 9, September 2016, Pages 1231-1255
Mayo Clinic Proceedings

Special article
New Insulin Delivery Recommendations

https://doi.org/10.1016/j.mayocp.2016.06.010Get rights and content
Under a Creative Commons license
open access

Abstract

Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes.

Abbreviations and Acronyms

BMI
body mass index
CSII
continuous subcutaneous insulin infusion
FIT
Forum for Injection Technique
FITTER
Forum for Injection Technique and Therapy: Expert Recommendations
GLP-1
glucagon-like peptide-1
HCP
health care professional
IM
intramuscular
ITQ
Injection Technique Questionnaire
LH
lipohypertrophy
NPH
neutral protamine Hagedorn (also known as Insulin N)
NSI
needlestick injury
SC
subcutaneous
TITAN
Third Injection Technique workshop in AtheNs

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For editorial comment, see page 1155; for related articles, see pages 1212 and 1224

Potential Competing Interests: All the authors are members of the Scientific Advisory Board (SAB) for the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER). FITTER and the Injection Technique Questionnaire survey were sponsored by BD, a manufacturer of injecting devices, and SAB members received an honorarium from BD for their participation on the SAB. Drs L.J. Hirsch, Smith, and Strauss are employees of BD.