Utilización correcta de los dispositivos de insulina en el control de la diabetes tipo II y factores asociados

2020 
espanolObjetivo: describir la utilizacion de dispositivos de insulina en personas con diabetes mellitus y la relacion de posibles factores asociados con el uso correcto o incorrecto de dichos dispositivos. Metodo: estudio descriptivo transversal. Ambito del estudio: centro de Atencion Primaria urbano, Hospitalet de Llobregat, Barcelona. Pacientes con diabetes mellitus tipo 2 insulinodependientes ≥ 50 anos. Calculo muestral aleatorio (n= 168 con IC95%, precision ±5%), para estimar un porcentaje poblacional previsto del 80%, y porcentaje reposicional del 10%. Muestreo sistematico no probabilistico. Variables: manipulacion correcta de dispositivo de insulina, caracteristicas sociodemograficas, caracteristicas relacionadas con el tratamiento y adherencia a la insulina, patologias concomitantes, miedos y reticencias. Analisis descriptivo univariante y bivariante. Resultados: 162 personas con diabetes mellitus insulinodependientes, el 59,3% se administra correctamente insulina. El 51,8% refiere haber tenido problemas en la piel, relacionandose con un mayor numero de pinchazos (p= 0,027). El 50% afirma que ha olvidado ponerse la insulina (p= 0,001). El 38,1% refleja que en alguna ocasion no recuerda las indicaciones del profesional sanitario sobre la utilizacion de insulina (p= 0,021). De los pacientes que presentan deterioro visual, al 22,9% le costaba administrarse la insulina una vez cargada (p= 0,038). En el caso de padecer deterioro manipulativo, al 21,5% le tiembla la mano mientras carga la insulina (p= 0,001) y al 26,2% asegura que una vez cargada le cuesta administrarsela (p= 0,012). Conclusiones: diversos factores conducen a errores en la autoadministracion de insulina, sugiriendo una revision periodica comprobada de la tecnica y una reeducacion sobre la autoadministracion adecuada fomentando la adherencia correcta al tratamiento. EnglishPurpose: to describe the use of insulin devices in patients with diabetes mellitus and the relationship of potential associated factors with the correct or incorrect use of such devices. Methods: a cross-sectional descriptive study. Study setting: a metropolitan Primary Care Center in Hospitalet de Llobregat, Barcelona. Patients with insulin-dependent type 2 diabetes mellitus, aged ≥ 50 years. Random sample calculation (n= 168 with 95%CI, precision ±5%) to estimate a predicted 80% population rate and a 10% replacement rate. Non-probabilistic systematic sampling. Variables: correct handling of the insulin device, sociodemographic characteristics, treatment-related characteristics and adherence to insulin therapy, comorbidities, fears and reluctances. A descriptive univariate and bivariate analysis. Results: 162 patients with insulin-dependent diabetes mellitus; 59.3% were correctly administering insulin. 51.8% reported skin problems, which were related to a higher number of punctures (p= 0.027). 50% reported having forgotten to take their insulin (p= 0.001). 38.1% said that, occasionally, they had not remembered the instructions given by their health professional regarding the use of insulin (p= 0.021). Among the patients with visual impairment, 22.9% reported difficulties to administer insulin once loaded into the device (p = 0.038). Among patients with handling impairment, 21.5% had hand tremors while loading insulin (p= 0.001) and 26.2% reported that once loaded they had difficulty administering it (p= 0.012). Conclusions: several factors result in mistakes in insulin self-administration, which suggests the need for a verified regular review of the administration method and re-education on the correct self-administration to promote treatment adherence.
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