With an urgent need to improve diabetes management and insulin therapy, Forum for Injection Technique & Therapy Expert Recommendations (FITTER) India recommendations 2017 were released in Kolkata today with leading clinical experts in diabetes care – Dr. Subhankar Chowdhury, Professor and Head, Dept. of Endocrinology, IPGME&R and SSKM Hospital, Dr. Debashish Majhi, Professor and Head, Vivekanand Institute of Medical Sciences, Kolkata and Dr. Larry Hirsch, Vice President of Global Medical Affairs, Diabetes Care Business, BD at The Press Club, Kolkata.
Surprisingly the global insulin injection technique questionnaire (ITQ) survey that was conducted among ~14,000 patients from over 400 centers in 42 countries revealed very low levels of awareness of insulin injection technique among patients. One of the principal countries participating in the ITQ was India, with an input of over 1000 patients from 20 centers representing all the major regions of the country with 3 centers from East.
- Dr. Sujoy Ghosh AMRI Medical Centre Kolkata
- Dr. Debmalya Sanyal KPC Medical College and Hospital, Kolkata
- Dr. C Bhattacharya Sun Valley Hospital, Guwahati
Commenting on the importance of correct injection practices, Dr. Subhankar Chowdhury, Professor and Head, Dept. of Endocrinology, IPGME&R and SSKM Hospital, Kolkata, said, “With only about 3 million injecting insulin out of 69.2 million who live with diabetes, India has low rates of insulinisation. This is a road block in the optimal management of diabetes. Patients fear initiating insulin partly because of fear of needles and a sense of life-long dependence on insulin. Also, many clinicians hesitate to put their patients on insulin therapy as they apprehend losing their patient’s confidence to this fear. However, awareness on correct insulin administration technique plays a critical role in therapy adoption, adherence and management of diabetes. While prescribing insulin therapy, physicians’ role is not restricted to deciding the dosage and timing of insulin but goes onto counseling the patients around selecting the correct site, deciding the right depth, selecting the right device and appropriate needle length.. Shorter needles can provide safety from injecting into muscle, as an insulin injection in the muscle may lead to hypoglycemia. The key recommendations of FITTER are that the shortest needles (currently 4 mm in pens & 6mm in syringes), are safe, effective and less painful and should be the first line of choice in all patient categories.”
This is one of the largest surveys of its kind ever performed in diabetes and provides landmark data on Indian injectors. Despite the fact that India is ahead of the curve in using the shortest needles, there is a disturbingly high rate of needle reuse with both syringes and pens. 55.8% of interviewed patients reuse their syringes for insulin use, mostly for convenience or to save costs. Approx. 40% use their pen needles more than 5 times. There were low levels of awareness in patients on aspects like site rotation, injection related swellings and related concerns of insulin injection technique.
Dr. Debashish Majhi, Professor and Head, Vivekanand Institute of Medical Sciences, Kolkata added, “Pain during injection, fear of injection or hypoglycemia, social stigma and lack of education can be barriers in initiating insulin therapy. Insulin injection is not at all painful. Optimization of injection technique with respect to the individual patient needs is critical for the success of injectable therapy, making injection more comfortable and less painful. The FITTER recommendations suggest that correct injection technique can also, help protect against lipohypertrophy, unexplained hypoglycemia (low blood glucose) and blood glucose variation. Several factors including regular inspection of injection sites, preventing reuse of needle, correct site rotation, influence the success of insulin injection therapy. FITTER India recommends that ideally needles should not be reused as blunt needles can damage tissues and then injection may be painful.”
The findings from ITQ survey helped revise the existing recommendations by the Forum for Injection Technique (FIT) India and release the updated, FITTER India Recommendations 2017 which include; barriers of insulin injection therapy and preventive measures, updated recommendations on device specifications for a given patient, insulin injection practices in indoor settings, adverse safety outcomes of faulty techniques and measures to enhance awareness of the good injection practices among HCPs and patients.
Highlighting their role as a partner committed to diabetes care, Dr. Laurence Hirsch, Vice President of Global Medical Affairs, BD Medical-Diabetes Care said, “Even the appropriate type of insulin and correct dose might not necessarily give the intended results without following the right injection practices. For the management of insulin-dependent diabetes, proper injection technique is crucial to ensure the desired clinical and patient outcomes.”
The FITTER India recommendations are based on Global Injection Technique Questionnaire Study, updates on local and global clinical evidence after robust published literature search and the global FITTER meeting that was held in Rome in the year 2015 and included over 150 key opinion leaders from all over the world and more than 15000 healthcare professionals who connected virtually to the Congress. Further, the highly valued Indian results of the ITQ survey have been published in an International Journal of repute- Diabetes Therapy, March 2017.