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Diabetes Therapy

, Volume 8, Issue 3, pp 637–657

First Online: 13 March 2017Received: 19 December 2016DOI: 10.1007-s13300-017-0243-x

Cite this article as: Kalra, S., Mithal, A., Sahay, R. et al. Diabetes Ther 2017 8: 637. doi:10.1007-s13300-017-0243-x


IntroductionIt was estimated that 3.2 million Indians with diabetes injected insulin in 2010, but little is known about the techniques used.

MethodsIn 2015 we conducted an injection technique questionnaire ITQ survey throughout India involving 1011 patients. Indian values were compared with those from 41 other countries participating in the ITQ, known here as rest of world ROW.

ResultsMean HbA1c was 8.6. BMI values in India were 1.5–3 units lower than in ROW depending on patient group, meaning the risk of intramuscular IM injections is high in India. The mean total daily dose TDD of insulin was lower in every category of Indian patient than in ROW, perhaps reflecting the lower BMI. Needle reuse, whether with pens or syringes, is much higher in India than ROW and so is the number of times the needle is used. The majority 56.8% of Indian insulin users performed only 2 injections-day as opposed to ROW where 45% of patients performed at least 4 injections-day. Indian patients inject insulin in the thighs more often than patients in ROW, a site where IM injections are more risky. Many patients do not have proper access to sharps containers or have other risk factors that could lead to blood-borne pathogen spread. More than 60% of used sharps in India go into the rubbish, with nearly 12% not even having the minimum protection of a cap.

DiscussionThe shortest needles are very common in India; however, the level of needle reuse is high. Multiple daily injections therapy is not as common in India as ROW. More focus needs to be given to dwell times under the skin, reconstitution of cloudy insulins, skinfolds, and safe sharps disposal.

KeywordsInfusions Injections Insulin Lipodystrophy Lipohypertrophy Needles Needlestick Subcutaneous Enhanced contentTo view enhanced content for this article go to

Autor: Sanjay Kalra - Ambrish Mithal - Rakesh Sahay - Mathew John - A. G. Unnikrishnan - Banshi Saboo - Sujoy Ghosh - Debmalya S


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