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.