Are the insulin injection guidelines really evidence-based? A systematic review of different guideline recommendations regarding insulin injection

Objective The purpose of this systematic review was to evaluate evidence for different guideline recommendations regarding needle reuse, rotation, injection site for a certain type of insulin and needle length, and to assess whether these recommendations are evidence-based. Methods A search of computer was carried out in PubMed, Medline, Embase, CNKI, Weipu data, Wanfang data from 1946 to December 2016, and diabetes education official websites in United States, Australia, Canada, Denmark, Hongkong (China), Netherlands and United Kingdom for insulin injection guidelines published before December 2016. All inclusions of guidelines for insulin injection followed the criteria of inclusion and exclusion. Two researchers independently screened and evaluated the quality of included guidelines with Appraisal of Guidelines for Research and Evaluation, and then extracted relevant data for analysis. Results In the original search, 967 100 literatures were identified, and 10 guidelines were included in the final review. Guidelines were published from 2007 to 2016. We found that evidence of recommendations on using the pen needle only once, rotating the injection sites among different anatomic areas (abdomen, thigh, arm and buttocks) and determining the injection sites by insulin type are not accurate enough. Conclusion In these existing guidelines for insulin injection, some recommendations are not fully strict. Further randomised clinical trial is warranted to provide scientific basis for developing the recommendations. Key words: Insulin injection; Guideline; Systematic review