Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: FITTER: Forum for Injection Techniques & Therapy Expert Recommendations
Sue Ward, Principal Pharmacist, Ward MM
FITTER is the latest in a series of scientific seminars to improve the management of Diabetes for healthcare professionals and patients around the world and based on results from injection techniques study with 13,264 respondents from 42 countries. FITTER promotes evidence based clinical best practice of diabetes injectable which will lead to improved health outcomes, well being, lower healthcare costs and reduced burden on care providers. FITTER is a major milestone in the history of diabetes care, bringing about a paradigm shift where injection technique is regarded as important as insulin, diet and activity. One suite of recommendations focuses upon best practice in insulin administration. Recommendations are summarised as follows:
- Insulin and glucagon-like peptide-1 receptor agonists must be deposited into healthy subcutaneous fat tissue, avoiding the intradermal and IM spaces as well as scars and LH.
- 4-mm pen needles inserted at 90° are recommended for all adults regardless of age, sex, ethnicity, or BMI. If patients need to use needle lengths >4 mm or a syringe (or where the presumed skin surface to muscle distance is less than the needle length), they must use a correctly lifted skinfold to avoid IM injections.
- Recommended sites for injection are the abdomen, thigh, buttock, and upper arm: Abdomen within the following boundaries: ∼1 cm above the symphysis pubis, ∼1 cm below the lowest rib, ∼1 cm away from the umbilicus, and laterally at the flanks. Other sites could include the upper third anterior lateral aspect of both thighs, posterior lateral aspect of both upper buttocks and flanks, and the middle third posterior aspect of the upper arm
- Detect and avoid injection into areas of lipodystrophy.
- Rotation of injection sites is critically important and can be correctly performed by spacing injections within a site approximately one fingerbreadth apart, and using a single injection site no more frequently than every 4 weeks.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.