{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T17:49:57Z","timestamp":1784224197166,"version":"3.55.0"},"reference-count":50,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T00:00:00Z","timestamp":1730678400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Appropriate insulin injection technique can help to enhance positive clinical outcomes in insulin\u2010treated patients. This cross\u2010sectional survey was undertaken to assess the present state of injection technique practices of patients administering insulin and the incidence of local complications associated with insulin injection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study was conducted at 11 tertiary hospitals in Xi'an City. A total of 1370 patients with diabetes were enroled in the survey. Each patient was asked questions on the Injection Technique questionnaire, demonstrated insulin injection on an injection training pad and had their injection sites inspected by a nurse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>About 98% of participants were type 2 diabetic patients. The 5\u2009mm length needles were used by 640 (46.71%) patients. Around 1286 participants reused pen needles. Only one\u2010third of patients rotate the injection sites. Around 901 patients had ecchymosis at injection sites, 43 participants suffered rash and or pruritus and 661 patients had lipohypertrophy. About 2.99% of patients reported having infection at the injection sites. Most patients (72.55%) occasionally felt pain when injecting insulin. The results of the multivariable logistict analysis showed that gender (male), needle length, priming the pen before injections and correct site rotation were negatively associated with the incidence of injection site ecchymosis. Lower incidence of lipohypertrophy was associated with needle length 4\u2009mm, needle length 6\u2009mm, single use of pen needles, priming the pen before injections and correct site rotation. Higher incidence of injection site infection was related to not disinfecting injection sites before each injection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite some improvements detected in some aspects of patients' insulin injection practice in recent years, a large gap still exists between insulin injection guidelines and patients' actual injection behaviour. Injection\u2010related complications at injection sites are still considerably common among our study population. Patients' education regarding insulin injection technique should be conducted repeatedly and regularly to make sure patients' compliance to injection guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.14226","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T05:20:43Z","timestamp":1730697643000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Insulin Injection Technique and Related Complications in Patients With Diabetes in a Northwest City of China"],"prefix":"10.1111","volume":"31","author":[{"given":"Tao","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Radiology The First Hospital of Northwest University Xi'an Shaanxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Urology The First Hospital of Northwest University Xi'an Shaanxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Endocrinology The First Hospital of Northwest University Xi'an Shaanxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2843-8082","authenticated-orcid":false,"given":"Xiangjun","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Nursing The First Hospital of Northwest University Xi'an Shaanxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,4]]},"reference":[{"issue":"9","key":"e_1_2_9_2_1","article-title":"Assessment of Insulin Injection Technique Among Diabetic Patients in Makkah Region in Saudi Arabia","volume":"12","author":"Alhazmi G. 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