Insulin injection practices among youngsters with diabetes in Tikur Anbesa Specialized Hospital, Ethiopia



The main aim of this study was to explore how participants were practicing insulin injections and assess its association with the insulin related-outcomes.


A hospital-based cross-sectional study was conducted among 176 youngsters with diabetes in Tikur Anbesa Specialized Hospital, Ethiopia. The inclusion criterion was the use of insulin treatment for a minimum of one year. Data about insulin injection practices was derived from participants’ report. Descriptive statistics was presented using frequency distributions and percentages for categorical variables while measure of central tendencies and dispersion for continuous variables. Chi-square test was employed to test for the association between compared variables.


Participants were asked on how frequent they practice the appropriate insulin injecting practices. Based on that, eliminating air bubbles from a syringe, lifting skin fold during an injection, inserting a needle deep enough in the subcutaneous tissue, inspecting injection sites and self-monitoring of blood glucose were frequently done practices in more than 80% of the participants. Besides, over half of the participants reported that they frequently practice; insulin vial inspection, physical exercise, inject 1–3 cm apart from previous site, and insert a needle at 450. Regarding insulin storage, more than half of them store opened insulin in the refrigerator, though it is advisable to store it at room temperature. Appropriate injection site rotation was reported by nearly one-third of the participants. Questions such as; gentle re-suspension of cloudy insulin, adjust insulin dose when necessary and change insulin syringe at every injection were reported by very few of the participants. Coming to glycemic control of our study subjects, 83% of them had HgbA1C of above 7.5% (non-optimal) and 31% reported at least one episode of hypoglycemia. Non-optimal glycemic control was explained by poor injection site hygiene (p < 0.038) and infrequent inspection of injection sites (p < 0.049).


Compared to previous studies, this study came with higher proportion of participants who frequently practice the appropriate insulin injection practices. However, it is still important to educate patients on some crucial injecting practices.

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Data availability

The datasets supporting the conclusions of the study are available with the authors. Any additional data will be available on request.



Association of Clinical Diabetologists


Italian Diabetes Healthcare Professionals


Body Mass Index

CI :

Confidence Interval


Forum for Injection Technique

HbA1C :

Glycated Hemoglobin

LH :


mg/dL :

milligram per deciliter

SD :

Standard deviation


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The authors gratefully acknowledge all participants of the study and Tikur Anbesa Specialized Hospital for allowing us to do our study.

Code availability

Code was given for each variable entered to the statistical software which was used for data analysis.


This work was supported by Addis Ababa University.

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Correspondence to Afewerki Gebremeskel Tsadik.

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Ethics approval

This study was conducted in accordance with the Declaration of Helsinki, and approval for the study protocol was granted by the Ethics Review Board of Tikur Anbesa Specialized Hospital.

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Participants and their parents were informed of their written consent prior to involving them in the study. Human rights were kept safe throughout the study.

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Consent is received from all authors to publish the study.

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Tsadik, A.G., Gidey, M.T., Assefa, B.T. et al. Insulin injection practices among youngsters with diabetes in Tikur Anbesa Specialized Hospital, Ethiopia. J Diabetes Metab Disord (2020).

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  • Diabetes mellitus
  • Insulin injection techniques
  • Hypoglycemia
  • Glycemic control