Insulininjektion und Schmerz bei Kindern mit Diabetes mellitus - eine prospektive, kontrollierte, nicht-interventionelle Beobachtungsstudie

Abstract

Aims: Discomfort during insulin injection and self-monitoring of blood glucose (SMBG) is a potential obstacle for successful insulin treatment, but its prevalence and extent in relation to clinical and other variables is not entirely clear. Methods: In a prospective, population-based study we assessed treatment-associated discomfort and pain in an unselected cohort of patients (60 boys and 52 girls; mean age 14.6^± 3.0 years, mean HbA1c 8.0 ± 1.4 percent) with type 1 diabetes and multiple daily self-injections of insulin. Pain perception during injection and SMBG was measured by adapted visual analogue and verbal rating scales, with pain scores ranging from 0 to 10. A six-item questionnaire was used to evaluate patient discomfort, preferences and satisfaction. Results: Pain during insulin injection was absent to very low in 103 of 112 (91.9 percent) patients, and its intensity was independent of age, gender, diabetes duration, current HbA1c, injection volume, or type of insulin used. Insulin injection was more unpleasant than SMBG in 64.2 percent of patients (mean difference of pain score, 1.0 ± 1.7, p < 0.0001). Injection into the upper arm (score, 2.9 ± 2.1) was less painful than into the thigh (score, 4.1 ± 2.4, p = 0.0139) and abdomen (score, 3.8 ± 2.2, p = 0.0400). Surprisingly, painlessness of injection and SMBG was not judged an important treatment goal by 22.0 percent and 32.9 percent of patients, respectively. Logistic difficulties (41.2 percent of responses) and time requirements (23.8 percent of responses), but not pain (10.1 percent of responses) were considered the most disturbing aspects of insulin injections. Conclusion: In young patients with access to optimized diabetes education and technology, pain during insulin injection and SMBG is infrequent or mild, and not widely perceived as problematic.