Effectiveness of Insulin Injection Technique on Glycemic Control of Fasting Plasma Glucose and HbA1c in Type II DM Patients at Hasanuddin University Hospital: Randomized Controlled Trial
DOI:
https://doi.org/10.20956/icon.v9i2.42527Keywords:
fasting plasma glucose, glycemic levels, HbA1c, insulin injection technique, type II DM patientsAbstract
Aims: To identify the effectiveness of insulin injection techniques (injection method, injection
location, insulin pen, and drug dose) on glycemic control of HbA1c and Fasting Plasma Glucose
(FPG) in Type II DM patients.
Methods: The design of this study was quantitative experimental using a Randomized Controlled
Trials (RCT) research design with non-blinding in patients with Type II Diabetes Mellitus who
had received insulin therapy. The sample consisted of 60 Type II DM patients and consisted of
30 intervention groups and 30 control groups.
Results: There were significant results on the level of knowledge (p=0.043), accuracy of insulin
use (p=0.002), and insulin injection skills (p=0.017) in patients in the intervention group before
and after education, but there was no significant difference in the control group. In addition, in
the intervention group, there was a substantial and controlled decrease in GDP and HbA1c levels
with a value of (p=0.000), while in the control group, there were no significant results with
(p=0.104).
Conclusion: Our findings highlight the role of insulin injection techniques (injection method,
injection site, insulin pen use, and dosage) in controlling FPG and HbA1c glycemic levels in
patients with Type II DM.
References
Abujbara, M., Khreisat, E. A., Khader, Y., & Ajlouni, K. M. (2022). Effect of insulin
injection techniques on glycemic control among patients with diabetes. International
Journal of General Medicine, 15, 8593–8602.
https://doi.org/10.2147/IJGM.S393597
American Diabetes Association. (2020, December 19). ADA releases 2021 standards of
medical care in diabetes centered on evolving evidence, technology, and
individualized care. https://diabetes.org/newsroom/ADA-releases-2021-
standards-of-medical-care-in-diabetes
American Diabetes Association. (2024). Facilitating positive health behaviors and well-
being to improve health outcomes: Standards of care in diabetes—2024. Diabetes
Care, 47(Suppl. 1), S77–S110. https://doi.org/10.2337/dc24-S005
American Diabetes Association. (2025). Glycemic goals and hypoglycemia: Standards of
care in diabetes—2025. Diabetes Care, 48(Suppl. 1), S128–S145.
https://doi.org/10.2337/dc25-S006
Barnard-Kelly, K. D., Mahoney, E., Baccari, L., Oliveria, T., Glezer, S., Berard, L., et al.
(2021). Injection technique: Development of a novel questionnaire and user guide.
The American Diabetes Association Journal, 34(2), 156–165.
https://doi.org/10.2337/figshare.13237364
Bari, B., Corbeil, M. A., MacNeill, G., Puebla-Barragan, S., & Vasquez, A. (2023).
Addressing insulin injection technique: A follow-up study of Canadian patients with
diabetes. Diabetes Therapy, 14(12), 2057–2074. https://doi.org/10.1007/s13300-
023-01479-1
Djahido, M., Wiyono, W. I., & Mpila, D. A. (2020). Insulin use patterns in type 1 diabetes
mellitus patients in the outpatient installation of Prof. Dr. R. D. Kandou Manado
General Hospital. PHARMACON Scientific Journal of Pharmacy UNSRAT, 9(1).
https://doi.org/10.35799/pha.9.2020.27413
Ehrmann, D., Kulzer, B., Wienbarg, I., Sieber, J., Weber, S., Haak, T., et al. (2023).
Assessing barriers and adherence to insulin injection technique in people with
diabetes: Development and validation of new assessment tools. Journal of Diabetes
Science and Technology. https://doi.org/10.1177/19322968231175920
Gorska-Ciebiada, M., Masierek, M., & Ciebiada, M. (2020). Improved insulin injection
technique, treatment satisfaction, and glycemic control: Results from a large cohort
education study. Journal of Clinical and Translational Endocrinology, 19.
https://doi.org/10.1016/j.jcte.2020.100217
Kalra, S., Pathan, F., Kshanti, I. A. M., Bay, N. Q., Nagase, T., Oliveria, T., et al. (2023).
Optimizing insulin injection techniques to improve diabetes outcomes. Diabetes
Therapy, 14, 1785–1799. https://doi.org/10.1007/s13300-023-01460-y
Kamrul-Hasan, A. B. M., Hannan, M. A., Asaduzzaman, M., Rahman, M. M., Alam, M.
S., Amin, M. N., et al. (2022). Prevalence and predictors of diabetes distress among
adults with type 2 diabetes mellitus: A facility-based cross-sectional study of
Indonesian Contemporary Nursing Journal, 9(2), 2025, 134-143
143
Bangladesh. BMC Endocrine Disorders, 22(1). https://doi.org/10.1186/s12902-
022-00938-3
Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Kaabi, J. A.
(2020). Epidemiology of type 2 diabetes - Global burden of disease and predicted
trends. Journal of Epidemiology and Global Health, 10(1), 107–111.
https://doi.org/10.2991/JEGH.K.191028.001
Liang, K., Xie, Q., Nie, J., & Deng, J. (2021). Study on the effect of education for insulin
injection in diabetic patients with new simulation tools. Medicine (United States),
100(14), E25424. https://doi.org/10.1097/MD.0000000000025424
Masierek, M., Nabrdalik, K., Janota, O., Kwiendacz, H., Macherski, M., & Gumprecht,
J. (2022). The review of insulin pens—Past, present, and look to the future. Frontiers
in Endocrinology, 13. https://doi.org/10.3389/fendo.2022.827484
Mehrabbeik, A., Namiranian, N., Azizi, R., Meybody, M. A., Shariati, M., & Kohani, H.
A. M. (2022). Investigation of association between insulin injection technique and
blood glucose control in type 2 diabetes patients. International Journal of
Endocrinology and Metabolism, 20(4). https://doi.org/10.5812/ijem-128392
Mobasseri, M., Shirmohammadi, M., Amiri, T., Vahed, N., Fard, H. H., & Ghojazadeh,
M. (2020). Prevalence and incidence of type 1 diabetes in the world: A systematic
review and meta-analysis. Health Promotion Perspectives, 10, 98–115.
https://doi.org/10.34172/hpp.2020.18
Selvadurai, S., Cheah, K. Y., Ching, M. W., Kamaruddin, H., Lee, X. Y., & Ngajidin, R.
M., et al. (2021). Pharmacist insulin injection re-education impacts glycemic control
among type II diabetic patients in primary health clinics. Saudi Pharmaceutical
Journal, 29(7), 670–676. https://doi.org/10.1016/j.jsps.2021.04.028
Soetmadji, D. W. (2021). Practical guidelines for insulin therapy in patients with diabetes
mellitus (1st ed.).
Trief, P. M., Cibula, D., Rodriguez, E., Akel, B., & Weinstock, R. S. (2023). Incorrect
insulin administration: A problem that warrants attention. Clinical Diabetes, 34(1),
25–33. https://doi.org/10.2337/diaclin.34.1.25
Tulsan, S. K., et al. (2024). Errors in diabetic insulin therapy and the vitality of proper
precautions in Bangladesh: Real-life insights from the developing world. Journal of
Family Medicine and Primary Care, 13(1), 292–297.
https://doi.org/10.4103/jfmpc.jfmpc_484_23
Ucieklak, D., et al. (2022). Insulin-induced lipohypertrophy in patients with type 1
diabetes mellitus treated with an insulin pump. International Journal of
Endocrinology, 2022. https://doi.org/10.1155/2022/9169296
Vickerstaff, V., Omar, R. Z., & Ambler, G. (2019). Methods to adjust for multiple
comparisons in the analysis and sample size calculation of randomized controlled
trials with multiple primary outcomes. BMC Medical Research Methodology, 19(1).
https://doi.org/10.1186/s12874-019-0754-4
Wu, Q., Deng, M., Wang, W., Yu, S., Wang, M., Sun, C., et al. (2023). A self-controlled,
cross-over study of intensive insulin treatment with needle-based injection versus
needle-free injection in hospitalized patients with type 2 diabetes. Frontiers in
Endocrinology (Lausanne), 14. https://doi.org/10.3389/fendo.2023.1162176
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
