Efficacy of education on injection technique for patients diagnosed with diabetes with lipohypertrophy: systematic review and meta-analysis

Abstract

Objectives: This study aimed to investigate the efficacy of providing education on injection technique to patients with diabetes with lipohypertrophy (LH).

Design: We conducted a systematic review and meta-analysis.

Methods: We included patients with diabetes who use insulin and have LH, and excluded patients without LH. We performed a literature search on CENTRAL, MEDLINE, EMBASE, ICTRP and ClinicalTrials.gov in November 2021 for randomised controlled trials (RCTs). We used the revised Cochrane Risk of Bias 2 tool to evaluate the risk of bias in each outcome in each study. We then pooled the data using a random-effects model and evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.

Outcome measures: The primary endpoints were change in total daily dose (TDD) of insulin, change in HbA1c levels and prevalence of hypoglycaemia.

Results: We screened 580 records and included three RCTs (637 participants) in the meta-analysis. Education on injection technique may slightly increase the change of TDD of insulin (three studies, 637 participants: mean difference (MD) -6.26; 95% CI -9.42 to -3.10; p<0.001; I²=38%; low certainty of evidence) and may have little to no effect on change in HbA1c but the evidence is very uncertain compared with that in the control group (three studies, 637 participants: MD -0.59; 95% CI -1.71 to 0.54; p=0.31; I²=98%; very low certainty of evidence). Providing education about injection technique may have little to no effect on the prevalence of hypoglycaemia (three studies, 637 participants: risk ratio 0.44; 95% CI 0.06 to 3.13; p=0.41; I²=90%; very low certainty of evidence).

Conclusions: The present meta-analysis suggests that injection technique education may result in a slight reduction in the TDD of insulin. However, the effect of education on HbA1c, hypoglycaemia and cured LH is uncertain.

Protocol registration: DOI: dx.doi.org/10.17504/protocols.io.btiinkce.

Keywords: diabetes & endocrinology; education & training (see medical education & training); medical education & training.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Figure 2

Risk of bias evaluation for each outcome. The risk of bias was assessed using the Cochrane risk of bias tool for randomised trials. LH, lipohypertrophy; TDD, total daily dose.

Figure 3

Forest plots of primary and secondary outcomes. (A) Change in total daily dose of insulin. (B) Change in HbA1c levels. (C) Prevalence of hypoglycaemia. (D) Change in the proportion of patients with cured lipohypertrophy (LH).