Insulin therapy practice performed by people with diabetes in Primary Healthcare

Cunha, Gilmara Holanda da; Fontenele, Marina Soares Monteiro; Siqueira, Larissa Rodrigues; Lima, Maria Amanda Correia; Gomes, Maria Elisa Curado; Ramalho, Ane Kelly Lima

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2019002903620 copy

Insulin therapy practice performed by people with diabetes in Primary Healthcare

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyze insulin therapy performed by people with diabetes in Primary Healthcare.

Method

A cross-sectional, descriptive and quantitative study. Data collection was carried out through an interview using a form with sociodemographic, clinical and insulin therapy variables. Absolute and relative frequencies as well as prevalence ratio were calculated and the chi-squared test was used, with p<0.05 being significant.

Results

The sample consisted of 150 patients. Most were female (66.7%), aged 50-85 years (79.3%) and some were illiterate (16.7%). Type 2 diabetes (62.0%) with complications (42.7%), and using oral hypoglycemic agents and insulin stood out. Syringes/needles (83.1%), lancets (85.5%), reagent strips (91.0%) and insulin vials (93.8%) were stored incorrectly by the majority. The correct form predominated in preparation, application and transport. Waste was disposed of incorrectly. In the general analysis most performed the insulin therapy stages inappropriately (93.3%). Sociodemographic and clinical variables did not influence insulin therapy, but there was a significant difference in the intra-group analysis for incorrect performance in some groups.

Conclusion

Insulin therapy was inappropriately performed in most cases.

Diabetes Mellitus; Insulin; Primary Care Nursing; Primary Health Care; Health Education

Sociodemographic variables	N	%
Gender
Male	50	33.3
Female	100	66.7
Age range (in years)
≤ 29	11	7.3
30 – 39	06	4.0
40 – 49	14	9.3
≥ 50	119	79.3
Self-reported skin color
White	45	30.0
Black	11	7.3
Brown	93	62.0
Indigenous	01	0.7
Civil status
Single	33	22.0
Married/living together/consensual union	79	52.7
Widowed	18	12.0
Divorced/separated	20	13.3
Monthly Family income
< 1 minimum salary*	32	21.3
1 - 3 salaries	90	60.0
> 3 salaries	28	18.7
Employment situation
Employed	30	20.0
Unemployed	20	13.3
Retired	76	50.7
On leave	01	0.7
Homemaker	23	15.3
Number of people living in the home
Live alone	09	6.0
2	39	26.0
3	35	23.3
> 3	67	44.7
Education (in years)
Illiterate	25	16.7
< 8 years	55	36.7
8 – 12	52	34.7
> 12	18	12.0

Clinical variables	N	%
Type of DM*
DM*1	24	16.0
DM*2	93	62.0
Did not know	33	22.0
*Time of DM diagnosis (in years)**
0 – 9	54	36.0
10 – 19	63	42.0
20 – 29	22	14.7
More than 29 years	11	7.3
Complications related to DM*
No complications	86	57.3
Blindness/retinopathy	19	12.7
Cardiovascular	11	7.3
Diabetic foot	08	5.3
Nephropathy	02	1.3
More than one complication	24	16.0
Use of oral hypoglycemic agent(s)
Yes	113	75.3
No	37	24.7
Use of other medications
Yes	123	82.0
No	27	18.0
Smoking habit
Never smoked	94	62.7
Yes	07	4.7
Quit	49	32.7
Alcohol consumption
Never consumed	96	64.0
Yes	25	16.7
No	29	19.3

Insulin therapy stages	N	%
Insulin storage and supplies
Unused pens (N=37)
Correct	37	100.0
Incorrect	0	0.0
Pens being used (N=37)
Correct	37	100.0
Incorrect	0	0.0
Syringes and needles used (N=113)
Correct	19	16.9
Incorrect	94	83.1
Lancets used in blood glucose testing (N=145)
Correct	21	14.5
Incorrect	124	85.5
Reagent strips used in the blood glucose test (N = 145)
Correct	13	9.0
Incorrect	132	91.0
Used/open insulin vial (N=113)
Correct	07	6.2
Incorrect	106	93.8

Preparation before insulin application
Wash their hands with soap and water (N = 150)
Yes	143	95.3
No	07	4.7
Roll the insulin vial before aspirating (N = 113)
Yes	90	79.6
No	23	20.4
*Aspirate first to regulate if associated with NPH insulin (N = 82)**
Yes	68	82.9
No	14	17.1

Insulin application
Clean the application site with alcohol (N = 150)
Yes	64	42.6
No	86	57.3
Pinch the application site at a 90° angle (N = 150)
Yes	141	94.0
No	09	6.0
Wait 5 seconds after application (N = 150)
Yes	99	66.0
No	51	34.0
Systematically change the application site (N = 150)
Yes	139	92.7
No	11	7.3

Insulin therapy stages	N	%
Insulin transport
Correct	109	72.6
Incorrect	41	27.4

Disposal of insulin therapy waste
Syringes and needles (N = 113)
Correct	20	17.7
Incorrect	93	82.3
Lancets (N = 145)
Correct	21	14.5
Incorrect	124	85.5
Reagent tapes (N = 145)
Correct	13	9.0
Incorrect	132	91.0
Insulin vials (N = 113)
Correct	07	6.2
Incorrect	106	93.8
Cotton (N = 146)
Correct	137	93.8
Incorrect	09	6.2
Pens (N = 37)
Correct	06	16.2
Incorrect	31	83.8

Variables	Insulin therapy				Intragroup p-value*	PR^‡ (95%CI^§)	Intergroup p-value^†

	Adequate		Inadequate

	N	%	N	%
Age (in years)							0.102
< 50	0	0	30	100.0	-
≥ 50	10	8.3	110	91.7	< 0.0001
Gender							0.817
Male	3	6	47	94	0.206	0.857 (0.231 – 3.174)
Female	7	7	93	93	< 0.0001	1.011 (0.925 – 1.1104)
Civil status							0.001
Single	0	0	33	100.0	-
Married/Stable union	2	2.5	77	97.5	< 0.0001	0.12 (0.027 – 0.485)
Divorced/Widowed	8	21.1	30	78.9	< 0.0001	1.235 (1.044 – 1.460)
Education (in years)							0.662
< 8	6	7.5	74	92.5	0.527	1.313 (0.386 – 4.463)
≥ 8	4	5.7	66	94.3	0.499	0.981 (0.901 – 1.068)
Employment situation							0.502
Making income	8	7.5	98	92.5	0.058	1.66 (0.367 – 7.509)
No income	2	4.5	42	95.5	< 0.0001	0.969 (0.890 – 1.054)
Monthly Family income							0.915
< 1 minimum salary	2	6.3	30	93.8	0.058	0.922 (0.206 – 4.129)
≥ 1 minimum salary	8	6.8	110	93.2	< 0.0001	1.006 (0.908 – 1.113)
DM^\|\| diagnosis (years)							0.076
< 10 years	1	1.9	53	98.1	0.011	0.198 (0.026 – 1.517)
≥ 10 years	9	9.4	87	90.6	0.004	1.083 (1.006 – 1.116)
DM^\|\| complications							0.402
Yes	3	4.7	61	95.3	0.206	0.576 (0.155 – 2.141)
No	7	8.1	79	91.9	0.128	1.038 (0.955 – 1.128)
Number of medications							0.189
< 3	1	2.4	41	97.6	0.011	0.286 (0.037 – 2.186)
> 3	9	8.3	99	91.7	< 0.0001	1.065 (0.989 – 1.147)
Other comorbidities							0.495
Yes	9	7.3	114	92.7	0.011	1.976 (0.261 – 14.946)
No	1	3.7	26	96.3	< 0.0001	0.962 (0.880 – 1.052)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Gilmara Holanda da Cunha. Rua Alexandre Baraúna, 1115, Rodolfo Teófilo. CEP 60430-160 – Fortaleza, CE, Brazil. gilmaraholandaufc@yahoo.com.br