INTRODUCTION
The number of people with diabetes has risen to 422 million in 2014. Diabetes prevalence has been rising more rapidly in middle- and low-income countries. WHO estimates that diabetes was the seventh leading cause of death in 20161. Vietnam is situated in the Southeast Asia region with a surface area of 365,000 km2 and a population of approximately 97 million (2018), ranking as the 15th most populous country in the world2. Vietnam has both the highest and fasted-growing rate of diabetes in Southeast Asia. In Vietnam, the prevalence of diabetes has almost doubled within the past 10 years and has consequently been recognized as a major public health burden. In 2012, the prevalence of diabetes was 5.4%, with an additional 13.7% of individuals exhibiting impaired glucose tolerance3.
Insulin is the main treatment for type 1 diabetes (T1DM) and in many cases of uncontrolled type 2 diabetes (T2DM). According to the Institute of Safe Pharmaceutical Practices of America4, insulin is classified as a high-alert medication and associated with medication errors to use in the US. In 2004, a national report determined that 25% of all reports medication errors related to high-risk drugs and insulin-related problems accounted for 16%. Data published in 2010 indicated that the most common medication errors in the hospital involved in administration insulin5. The related issues include lack of knowledge about insulin, a misconception of the role of insulin therapy and errors in the practice of using insulin techniques in diabetic patients6-9. These are important causes that lead to non-adherence to medicines, reduce the effectiveness of treatment and increase the risk of adverse drug events such as severe hypoglycemia, injection sites reactions, and diabetes complications10,11.
Two-thirds of patients with T2DM in Vietnam had poor glycemic and metabolic control12. In many counties in the world, pharmacists play a key role in diabetes management and improvement of patient health13. However, Vietnamese pharmacists’ clinical role is still limited. The basic concepts of clinical pharmacy were introduced in Vietnam in 199014, and until 2012, the Ministry of Health released the Guidelines on Clinical Pharmacy Practice in Hospitals to encourage and develop clinical pharmacy activities15. Recently, Ministry of Health published Guidelines on Clinical Pharmacy Practice for non-communicable diseases (NCDs) in 201916 and diabetes is one of targeted NCDs for national programs. Medication errors involving insulin are common, particularly during the administration stage, and may cause severe harm. Little is known about the prevalence of insulin administration errors in hospitals, especially in resource-restricted settings in Vietnam. According to our knowledge, until now only one study of Nguyen et al17determined that the error rate in preparation and administration of insulin for inpatients was 28.8%, all with potentially moderate/severe outcome. They suggested that interventions suitable for resource-restricted settings need to be developed and tested to improve insulin preparation and administration, probably starting with education and providing information. Most diabetic patients are treated at home. Therefore, this study aimed to assess knowledge, attitude, and practice regarding insulin pen use among diabetic outpatients in a teaching hospital and determined related factors to the KAP, adverse drug reactions (ADRs) and glycemic control status. The study’s findings will help the hospital’s clinical pharmacy team to establish the next educational interventions for patients.