Indian Injection Technique Study: Injecting Complications, Education, and the Health Care Professional

Specifically, LH was present in 52.9% of participants. Patients were an average of 59.6 (SD = 11.5) years old and took insulin for 5.6 (SD = 4.6) years, averaging 33.0 (SD = 18.4) U/day. HbA1c was 8.2% (1.8) and 7.7% (1.5), respectively, in those with and without LH (p = 0.003). LH was associated with higher daily insulin dose (38.1 vs 27.1 U, p < 0.001) and cost [the Chinese currency, the Renminbi (RMB 8.2 vs 5.8, p < 0.001)]. Those with LH averaged 2.3 (2.2) nodes, had higher frequency of pen needle (PN) reuse (median 13.0 vs 7.5, p = 0.003), and greater total 6-month direct costs (RMB 5506.9 vs 5258.0, p = 0.037). With 8.4 million insulin injectors in China, the estimated excess annual direct cost of LH is RMB 2.2 billion ($360 million). Average pain scores (0–10) were higher if LH was present (2.7 vs 2.0, p = 0.021), if ≥3 nodes were present (3.8 vs 2.3, p < 0.001), and if PNs were not reimbursed (2.8 vs 1.7, p < 0.001). Patient satisfaction decreased as presence, number, and size of LH nodes increased (all p < 0.05).

Specifically the study investigated insulin exposure and pharmacodynamics of insulin lispro injected into abdominal areas with LH or normal adipose tissue. Thirteen T1DM with LH (confirmed by palpation and ultrasound) received single doses of 0.15 U/kg LIS approximately every 6 h, twice into a region with LHT and twice into normal tissue. Comparing LHT with NAT injection, LS-mean INS concentrations were comparable during the first 30 min (AUCINS0–0.5 h 8.8 vs 9.4 h mU/L), but significantly lower thereafter (AUCINS0–1 h 29.3 vs 41.5 h mU/L, AUCINS.0–4 h 97 vs 154 h mU/L, all p < 0.02). Maximum INS exposure was reduced by 34% (CINSmax 49.7 vs 75.4 mU/L, p < 0.002). The PD effect in the first 4 h was 27% lower with LHT injection (AUCGIR0–4 h: 529 vs 720 mg/kg, p < 0.05), whereas maximum GIR was comparable (GIRmax 5.5 vs 6.0 mg/kg/min, p = 0.378). Intrasubject variability was substantially higher after dosing into LHT (coefficients of variation 52% vs 11% [AUCINS.0–4 h] and 57% vs 23%, [AUCGIR0–4 h], all p < 0.002).