Insulin injection technique education and associated factors of knowledge: A cross-sectional survey on knowledge and practice of insulin injection technique education among physicians in Indonesia.

Background: Insulin therapy is crucial for type 2 diabetes mellitus management, with increasing usage in Indonesia, and its effectiveness is well-established. However, prescribing insulin poses various challenges that can impact the effectiveness of insulin. Patient education is crucial for the successful implementation of insulin therapy. Proper insulin use remains insufficient in Indonesia.

Objective: This study seeks to investigate physicians' knowledge and practice in providing education on insulin use to type 2 diabetes mellitus patients in Indonesia.

Methods: This study recruited potential participants (all physicians in Indonesia) through the Internet using a convenience sampling method. The participants were asked to fill out a questionnaire. The questionnaire had 32 questions divided into 4 sections, comprising demographics and clinical practice, practice of insulin education, Indonesian insulin injection technique guideline, and knowledge of insulin injection technique. The instrument used in this study was developed based on the Pedoman Teknik Menyuntik Insulin Indonesia (PTMII), which was adapted from the international consensus by the Forum for Injection Technique and Therapy Expert Recommendations (FITTER). The survey lasted from February to March 2021. Data was analysed using Kruskal-Wallis tests.

Results: A total of 823 participants were included in the analysis. A total of 680 out of 823 participants (82.6%) had given insulin education to patients at least once during the last 30 days. However, only 479 out of 823 participants (58.2%) used specific guidelines in their practice, with only 280 out of 823 participants (34.0%) aware of the Indonesian guidelines. Eight hundred and fifteen out of 823 participants (99.0%) agreed that insulin injection techniques would affect clinical results. The median score of knowledge about insulin injection techniques was 7 (interquartile range 2) among the study participants, indicating good knowledge. The profession was the only statistically significant variable associated with knowledge scores, with the highest median score held by consultants in endocrinology, metabolism & diabetes, and the lowest by other doctors (P <.001).

Conclusions: Most physicians in this study had given education to their patients. However, there was still a gap between the guidelines and the practice of insulin education, as shown by the lack of awareness and a fair level of knowledge about the Indonesian guidelines.