Factors related to tissue complications resulting from insulin therapy: a cross-sectional study

Santos, Wallison Pereira dos; Sousa, Mailson Marques de; Gouveia, Bernadete de Lourdes André; Soares, Maria Júlia Guimarães; Almeida, Ana Maria de; Oliveira, Simone Helena dos Santos

doi:10.1590/1980-220X-REEUSP-2021-0249

Brasil

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 56 • 2022 • https://doi.org/10.1590/1980-220X-REEUSP-2021-0249 linkcopy

Factors related to tissue complications resulting from insulin therapy: a cross-sectional study^*

Factores relacionados con las complicaciones tisulares derivadas de la terapia con insulina: estudio transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: To identify factors related to tissue complications resulting from insulin therapy.

Method: This is a descriptive, cross-sectional study carried out in a capital of northeastern Brazil. A semi-structured form and an observation guide were applied to assess the performance of insulin preparation and administration techniques. Descriptive statistics, association test, and multivariate logistic regression were used for data analysis.

Results: Most participants were female (74.2%), aged between 51 and 70 years (50.0%), and had nine to eleven years of education (36.7%). The presence of some type of local complication in 73.5% of the participants and the failure to rotate the injection sites in 82.3% are highlighted. Being single/widowed and not rotating insulin application sites were related to local complications and increased the chances of their occurrence by 3.51 and 6.70 times, respectively.

Conclusion: Marital status and nonrotation of injection site were related to the increased chances of tissue complications resulting from insulin therapy.

DESCRIPTORS Diabetes Mellitus; Insulin; Diabetes Complications; Needlestick Injuries; Nursing

Variables		Absolute (n)	Relative (%)	p-value
Age (years)	20–30	11	8.0	<0.001
	31–40	15	11.0
	41–50	19	13.9
	51–60	29	21.3
	61–70	39	28.6
	71–80	17	12.5
	≥81	6	4.4
Sex	Male	35	25.7	<0.001
Sex	Female	101	74.2	<0.001
Marital status	Single/Divorced/Widowed	57	41.9	0.0592
Marital status	Married/common-law marriage	79	58.0	0.0592
Family income (minimum wage)	<1	1	0.7	<0.001
	1	65	47.7
	≥2	70	51.4
Family arrangement	Live alone	15	11.0	<0.001
Family arrangement	Lives with family	121	88.9	<0.001
Years of studies	Never studied	10	7.3	<0.001
	1–4	39	28.6
	5–8	25	18.3
	9–11	50	36.7
	≥12	12	8.8
TOTAL		136	100.0

Variables		Local complications				p-value
		Yes		No
		n	(%)	n	(%)
Inputs
	Regular	6	6.0	2	5.6		0.5576
	NPH	43	43.0	17	47.2
Insulin type	Regular + NPH	32	32.0	9	25.0
	Lantus	5	5.0	–	–
	NR + Lantus	14	14.0	8	22.2
Type of syringe or pen	Graduation in IU	25	25.0	5	13.9	0.3905
	Graduation in IU	57	57.0	23	63.9
	Graduated in ml	1	1.0	1	2.8
	Application pen	17	17.0	7	19.4
Needle type	Fixed	10	10.0	4	11.1	0.9477
Needle type	Removable	90	90.0	32	88.9	0.9477
Needle diameter	04 mm	11	11.0	5	13.9	0.9163
	05 mm	14	14.0	4	11.1
	08 mm	31	31.0	10	27.8
	12 mm	44	44.0	17	47.2
Insulin therapy
Daily prescribed doses	1	17	17.0	12	33,3	0.0519
	2	40	40,0	14	38,9
	3	24	24,0	2	5.6
	4	10	10.0	3	8,3
	5	9	9,0	5	13.9
Application sites	Arms	23	23.0	7	19.4	<0.001
	Abdomen	64	64.0	14	38.9
	Thighs	2	2.0	2	5.6
	All	11	11.0	13	36.1
Carrying out rotation	Yes	11	11.0	13	36.1	<0.001
Carrying out rotation	No	89	89.0	23	63.9	<0.001
Reuse of syringes/needles	Yes	69	69.0	24	66.7	0.7962
Reuse of syringes/needles	No	31	31.0	12	33.3	0.7962

Variables	Model 1		Model 2		Model 3		Model 4
Variables	OR*	95% CI**	OR	95% CI	OR	95% CI	OR	95% CI
Sex
Female	1.00	–	1.00	–	1.00	–
Male	0.53	0.2–1.38	0.61	0.25–1.53	0,61	0,25–1,50
Marital status
Married/common-law marriage	1.00	–	1.00	–	1.00	–	1.00	–
Single/Divorced/ Widowed	3.63	1.32–9.96	3.44	1.28–9.24	3,23	1,23–8,50	3,51	1,35–9,12
Syringe type
Graduation in IU	1.00	–
Graduation in IU	0.45	0.14–1.47
Graduation in ml	0.09	0.00–2.10
Pen	0.68	0.13–3.46
Needle diameter
04 mm	1.00	–	1.00	–
05 mm	2.31	0.40–13.23	2.04	0.39–10.54
08 mm	2.54	0.55–11.74	2.33	0.54–9.98
12 mm	2.08	0.43–10.14	1.68	0.44–6.37
Injection site rotation
Yes	1.00	–	1.00	–	1.00	–	1.00	–
No	7.49	2.47–22.71	7.06	2.42–20.60	6.56	2.31–18.62	6.70	1.35–9.12

Variables	β	p-value	CI* (95%) for β
Variables	β	p-value	Lower	Upper
Injection site rotation	1.9017	0.0003	0.891	2.996
Marital status	1.2561	0.0098	0.351	2.281

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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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[TFN1] Source: Survey data, 2020. Chi-square/Fisher’s exact test.

*Current minimum wage in Brazil during the study period (2019): BRL 1,039.00.

Factors related to tissue complications resulting from insulin therapy: a cross-sectional study*

Factores relacionados con las complicaciones tisulares derivadas de la terapia con insulina: estudio transversal

Abstract

Factors related to tissue complications resulting from insulin therapy: a cross-sectional study^*