FITTER: New insulin delivery recommendations (1 September 2016)

Summary

This special article in Mayo Clinic Proceedings outlines practical recommendations for diabetes injections and infusions, developed at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Italy in 2015. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries. Recommendations are organised around the themes of anatomy, physiology, pathology, psychology and technology and aim to produce more effective therapies, improved outcomes and lower costs for patients with diabetes.

Content

Key recommendations include:

• that the shortest needles are safe, effective, and less painful and should be the first-line choice in all patient categories.
• intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result.
• lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, Therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them.
• effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started.
• inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens.
• mitigation is possible with proper training, effective disposal strategies and the use of safety devices.