Knowledge, Practice, and Complications of Insulin-Self Injection among a Representative Sample of Diabetic Patients in Southern Tunisia

Objective: Our study aimed to assess knowledge and practice of Tunisian diabetic patients regarding insulin-self-injecting and to determine insulin-injection complication as well as their independent factors.

Methods: It was a cross sectional study using investigator-administered-questionnaires among insulin self-injecting patients with DM attending Tunisian Endocrinology department on April 2021. Information regarding knowledge and practices relating to injection Technik and its complications were assessed by the insulin Injection-Technique-Questionnaire (ITQ).

Results: A total of 96 diabetic patients were included in the study. The median age was45 years with IQR=[36-60] years. There were 53(55.2%) subjects with diabetes type 1. Median insulin seniority was 10 years; IQR=[5-20] years. Prevalence of insulin-induced lipodystrophy among patients examined by healthcare worker was 55%. Independent factors of detected lipodystrophy were HBA1C level>10% (AOR=22), family history of diabetes (AOR=0.02), using warmed insulin (AOR=0.08), skin disinfection (AOR=0.005) and skin fold before injection (AOR=0.04). Prevalence of bleeding after injections was 87.5% (n=84). Its independent factors were skipping injections (AOR=27.6), HBA1C level>10% (AOR=10.6), seniority of diabetes>10 years (AOR=41.2) and history of chronic disease (AOR=15.4). Prevalence of pain while injecting was 54.2%. Independent factors of injection pain were having surgical history (AOR=20.2), dyslipidaemia (AOR=19), urban area (AOR=0.021), family history of diabetes (AOR=0.075) and insulin seniority>12 years (AOR=0.086). Leakage or backflow of insulin from skin was reported by 44 patients (45.8%). Its independent factors were dyslipidaemia (AOR=10.7), unmarried patients (AOR=4.7) and obese patients (AOR=0.1).

Conclusion: A poor level of knowledge as well as frequent insulin-injection-complications were observed. Thus, healthcare-providers should pay more attention to therapeutic education on insulin treatment.