Impact of pharmacist insulin injection re-education on glycemic control among type II diabetic patients in primary health clinics

BACKGROUND: Insulin injection technique re-education and diabetes knowledge empowerment has led to improved glycemic control. OBJECTIVES: To evaluate the impact of pharmacist’s monthly re-education on insulin injection technique (IT), lipohypertrophy, patients’ perception on insulin therapy and its effect on glycaemic control. METHODS: This randomized controlled, multi-centered study was conducted among type 2 diabetics from 15 government health clinics. 160 diabetics with baseline HbA1(C) ≥ 8% and unsatisfactory IT technique were randomized into control or intervention group. Control group received standard pharmacist counselling during initiation and at 4th month. Intervention group received monthly counselling and IT re-education for 4 months. Assessment of diabetes, IT knowledge, adherence and perception towards diabetes were conducted using validated study tools Insulin Treatment Appraisal Scale (ITAS) and Medication Compliance Questionnaire (MCQ)). RESULTS: 139 patients completed the study; control group (69), intervention group (70). In control group, all outcomes shown improvement except for patient’s perception. Mean HbA1(C) decreased 0.79% ± 0.24 (p = 0.001). In intervention group, all outcomes improved significantly. HbA1c reduces significantly by 1.19% ± 0.10 (p < 0.001). Monthly re-education improved patient’s perception towards insulin therapy (ITAS score reduced 1.44 ± 2.36; p = 0.021). Between groups, interventional arm shown significantly better improvement in all outcomes. Improvement was shown in IT technique (+2.02 score; p < 0.001), medication adherence (+1.48 score; p < 0.001) and ITAS (−1.99 score; p = 0.037). Mean HbA1(C) reduced an additional of 0.63% (p = 0.008) compared to control arm. CONCLUSION: Re-education is more effective in increasing adherence, reducing lipohypertrophy, improving injection technique and patient’s perception on insulin therapy, thereby providing better glycaemic control.