Actual state of injection techniques and effect of medical treatment instructions in elderly patients with diabetes using insulin

  • Ishida Hitomi
    Department of Nursing, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers
  • Fukuda Mariko
    Department of Nursing, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers
  • Kondoh Takaaki
    Department of Nursing, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers
  • Yamaguchi Yoko
    Department of Nursing, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers
  • Asahi Miho
    Department of Nursing, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers
  • Aikawa Chiyuki
    Department of Nursing, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers
  • Matsui Hiromi
    Department of Pharmacy, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers
  • Wakabayashi Yusuke
    Department of Internal Medicine, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers
  • Nakaya Masako
    Department of Internal Medicine, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers
  • Oka Rie
    Department of Internal Medicine, Hokuriku Central Hospital of Japan Mutual Aid Association of Public School Teachers

Bibliographic Information

Other Title
  • インスリン使用中の高齢糖尿病者における注射手技の実態と療養指導の効果
  • インスリン シヨウ チュウ ノ コウレイ トウニョウビョウシャ ニ オケル チュウシャ シュギ ノ ジッタイ ト リョウヨウ シドウ ノ コウカ

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Abstract

<p>Aim: Support for elderly patients using insulin to continue self-injection safely is required for clinical settings. The aim of this study was 1) to clarify the actual state of self-injection procedures for elderly people injecting insulin and 2) to verify whether or not the injection procedures can be improved by nurses' medical treatment instructions.</p><p>Subjects and Methods: The subjects were outpatients at an educational facility certified by the Japan Diabetes Society. Basic clinical characteristics, the Mini-Cog cognitive function test, basic ADL and instrumental ADL, and 24 items of the self-injection procedure were evaluated by nurses. After receiving a 30-minute face-to-face session of individual instructions from trained nurses two or more times, the injection procedure was re-evaluated.</p><p>Results: Of the 63 study subjects, 10 were injecting insulin with the support of others (supported injection group). The median age in the self-injection group was 72 years old, while that in the supported injection group was 82 years old. The supported injection group was older, the female ratio higher, and the Mini-Cog and ADL indices lower than in the self-injection group (p <0.05). The median history of the use of insulin was over 10 years in both groups. In the self-injection group, the degree of proficiency with the injection technique was significantly improved after receiving the instructions (p <0.05). The biggest improvement was in response to the question, "Do you know that you need to shift the site of injections?", which doubled (p <0.05). The correct answer rate for "Do you know the name of your insulin formulation?" was less than half, and it remained unchanged even after receiving instructions. In the supported injection group, 90% had a Mini-Cog of ≤2 points, but 6 subjects (60%) were able to perform an injection by themselves with others supporting the adjustments made to the amount of insulin.</p><p>Conclusions: The self-injection technique improved significantly, even in elderly people, following the delivery of medical treatment instructions by nurses, and the item with the highest improvement effect was subjects' understanding of the need to shift the injection site. Our study showed that even in elderly people with cognitive dysfunction who are performing injections with the support of others, some of the injection procedures were retained by relying on procedural memory acquired in the past.</p>

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