preprint · medRxiv
A cross-sectional study investigated skin-related complications from insulin therapy among 428 diabetic patients across four hospitals in Dar es Salaam, Tanzania. The investigation evaluated the occurrence of injection site abscesses and scarring, which threaten patient adherence to treatment. Researchers found that 22.2 percent of participants developed abscesses, while 46.7 percent experienced scar formation. Statistical analysis revealed that improper injection techniques and inadequate site rotation were major drivers of abscesses, whereas the use of insulin pens significantly reduced this risk. Similarly, scar formation was linked to improper site rotation, uncontrolled blood glucose levels, and sourcing insulin and syringes from community drug outlets. These findings demonstrate that injection site skin complications are common and suggest that structured patient education regarding proper injection practices could lower complication rates.
Insulin is critical for managing diabetes, but skin complications like abscesses and scars can discourage patients from taking their medication correctly. Identifying the causes of these adverse events helps healthcare systems design targeted patient education and improve supply quality, ensuring patients can safely and effectively manage their condition without painful side effects.
The findings highlight an applied clinical insight that could inform training programmes, educational materials, and delivery device choices for healthcare providers and diabetes management services. The demonstrated protective effect of insulin pens points to an existing, near-market product solution that healthcare systems could deploy to reduce adverse skin events compared to standard syringes.
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Abstract Background Globally, more than 530 million people live with diabetes mellitus (DM), and the burden continues to rise. Insulin remains the cornerstone of DM management worldwide. However, literature indicates that insulin users are at risk of developing abscesses and scar formation at injection sites. These complications may compromise adherence to therapy, thereby affecting the intended therapeutic outcomes. This study aimed to assess the prevalence of abscesses and scar formation at injection sites and their determinants among diabetic patients on insulin therapy in Dar es Salaam, Tanzania. Methods A hospital-based analytical cross-sectional study was conducted between February and May 2024. A total of 428 patients with DM on insulin therapy were enrolled from four selected hospitals in Dar es Salaam. A validated case report form (CRF) was used to collect socio-demographic characteristics and clinical data related to abscess and scar formation following insulin therapy. Data were analyzed using Stata version 15.0 software, with findings summarized as frequencies and percentages. Determinants of abscess and scar formation were assessed using modified Poisson regression, and a p-value of <0.05 was considered statistically significant. Results Out of 428 participants, 191 (44.6%) were aged over 45 years, 233 (54.4%) were female, and 185 (43.2%) had a primary education level. The prevalence of abscesses and scar formation was 95 (22.2%) and 200 (46.7%), respectively. Determinants of abscess formation included improper injection technique (aPR = 1.11; 95% CI: 1.02–1.21, p = 0.009), improper injection site rotation (aPR = 2.7; 95% CI: 1.13–6.45, p = 0.025), and the use of an insulin pen (aPR = 0.13; 95% CI: 0.04–0.48, p = 0.002). For scar formation, determinants included improper injection site rotation (aPR = 1.63; 95% CI: 1.03–2.32, p = 0.037), uncontrolled blood glucose levels (aPR = 1.69; 95% CI: 1.01–2.84, p = 0.049), and the use of insulin and syringes obtained from community drug outlets (aPR = 2.51; 95% CI: 1.22–1.98, p = 0.035). Conclusion The study identified a significant burden of abscess and scar formation among DM patients on insulin therapy. Key determinants included improper injection techniques, inadequate rotation of injection sites, and uncontrolled blood glucose levels. Regular training for DM patients on proper insulin injection practices is essential to minimize these complications.
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DOI: 10.1101/2025.02.25.25322829
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