Educational intervention on description of the insulin delivery technique: randomized clinical trial

Objective: to analyze the effect of educational intervention on insulin delivery technique. Methods: randomized clinical trial, carried out with 79 patients with Diabetes Mellitus, in two groups, 42 from the control group and 37 from the intervention. Four telephone calls were made in two months to the intervention group. The control group received only conventional follow-up. Results: when comparing the application of insulin in the pre and post-test, there was no significant difference (p>0.05) in the control group, but an improvement of 80.0% in the correct answers on the appropriate technique, with p<0.021 . In the intergroup comparison, the description of self-administration of insulin, after the telephone intervention, was better in 70.0% of the items, with p<0.030. Conclusion: the educational intervention via telephone improved the description of the technique of insulin application in patients with Diabetes Mellitus and their caregivers. Brazilian Registry of Clinical Trials number U1111-1228-3200. Descriptors: Diabetes Mellitus; Insulin; Telephone; Motivational Interviewing; Clinical Trial. RESUMO Objetivo: analisar o efeito de intervenção educativa via telefone sobre a descrição da técnica de aplicação de insulina. Métodos: ensaio clínico randomizado, realizado com 79 pacientes com Diabetes Mellitus, composto por dois grupos, 42 do grupo controle e 37 da intervenção. Realizaram-se quatro ligações telefônicas, em dois meses, para o grupo intervenção. O grupo controle recebeu somente acompanhamento convencional. Resultados: ao comparar a aplicação de insulina no pré e pós-teste, não houve diferença significativa (p>0,05) no grupo controle, mas melhoria de 80,0% no acerto das respostas sobre a técnica adequada, com p<0,021. Na comparação intergrupo, a descrição da autoaplicação de insulina, após a intervenção telefônica, foi melhor em 70,0% dos itens, com p<0,030. Conclusão: a intervenção educativa via telefone melhorou a descrição da técnica de aplicação de insulina em pacientes com Diabetes Mellitus e respectivos cuidadores. Registro Brasileiro de Ensaios Clínicos número U1111-1228-3200. Descritores: Diabetes Mellitus; Insulina; Telefone; Entrevista Motivacional; Ensaio Clínico. *Extracted from the dissertation “Efetividade do suporte telefônico no conhecimento sobre a técnica de aplicação da insulina”, Universidade Federal do Piauí, 2019. 1Universidade Federal do Piauí. Picos, PI, Brazil. 2Universidade Estadual do Piauí. Picos, PI, Brazil. Corresponding author: Ana Roberta Vilarouca da Silva Rua Cícero Duarte, 905, Junco CEP: 64607-670. Picos, PI, Brazil. E-mail: vilarouca@ufpi.edu. br EDITOR IN CHIEF: Ana Fatima Carvalho Fernandes ASSOCIATE EDITOR: Ivana Cristina Vieira de Lima Tatiana Victória Carneiro Moura1 Antonia Fabiana Rodrigues da Silva1 Ana Larissa Gomes Machado1 Gerdane Celene Nunes Carvalho2 Ana Roberta Vilarouca da Silva1 How to cite this article: Moura TVC, Silva AFR, Machado ALG, Carvalho GCN, Silva ARV. Educational intervention on description of the insulin delivery technique: randomized clinical trial. Rev Rene. 2020;21:e44230. DOI: https://doi.org/10.15253/2175-6783.20202144230 Moura TVC, Silva AFR, Machado ALG, Carvalho GCN, Silva ARV Rev Rene. 2020;21:e44230. 2 Introduction With the increase in the population’s perspective on life, there were changes in lifestyle, such as an increase in Chronic Non-Communicable Diseases, including Diabetes Mellitus. In 2019, 463 million adults worldwide were diagnosed with Diabetes Mellitus, of which 79.0% lived in low and middle income countries(1). Insulin therapy is one of the main strategies for glycemic control in patients who have the disease. Adequate levels of glycated hemoglobin (HbA1c) are associated with a decrease in disease-related macro and micro vascular complications(2). With the advancement of technology and the great ease of adhesion to telephone sets, there was also an increase in the use of applications that facilitate communication(3). Information and communication technologies are considered promising in the field of health promotion, enabling support for self-care, adoption of healthy habits, exchange of information and emotional support. Among these technologies, the use of the telephone, used to make calls, send messages and access information via the internet, stands out for being cost-effective, in addition to being effective in adhesion to treatment(4). However, the implementation of telephone intervention as an educational practice in Brazil, in the context of Diabetes Mellitus, is recent and has gaps to be filled, to enhance the effectiveness of telephone intervention, as in any educational practice, making it necessary to use adequate instruments and protocols that support the health professional who will make the telephone calls(5). The telephone intervention, as a health technology in nursing care, can be considered an effective strategy for the user’s adhesion to the practice of self-care in patients with Diabetes Mellitus, in even one year of monitoring, as it was found an improvement in self-care about adequate nutrition, regular physical exercise, abstinence from smoking and alcoholism(6). In addition, other studies have shown that telephone intervention has a positive impact on improving glycohemoglobin and self-care in diabetes(7-9). From this perspective, diabetes self-management requires awareness of the importance of lifestyle changes, glycemic self-control and insulin administration methods, the most common route being subcutaneous, with different ways of administering it, such as the use of syringes, insulin pens and insulin pumps. However, studies have shown concerns and barriers associated with treatment, particularly regarding errors or inaccuracies associated with injectable therapies(6,10-11). Therefore, there is a need to use a strategy to overcome these barriers, reducing errors and inaccuracies in the management of insulin therapy that impacts the quality of life of these patients, such as the use of telephone interventions to promote health, as it is simple, comfortable, fast and low cost, in addition to bringing new possibilities for nurses. Thus, the objective was to analyze the effect of educational intervention via telephone on the description of the insulin delivery technique.