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Fulltext Lipohypertrophy prevalence and its associated risk factors in insulin-treated patients with type 2 diabetes in North Borneo, Malaysia

Nain RA, Thomas DC

Belitung Nurs J, 2022;8(6):521-528.
PMID: 37554235 DOI: 10.33546/bnj.2246

BACKGROUND: Insulin-treated diabetes patients are at high risk of developing lipohypertrophy, which can negatively impact treatment outcomes. Early detection of lipohypertrophy is crucial to preventing blood glucose fluctuation. Unfortunately, this clinical issue is often overlooked by nurses, causing the development of vascular complications, which leads to an increase in the morbidity and mortality of the type 2 diabetes mellitus population.
OBJECTIVE: This study was conducted to identify lipohypertrophy prevalence and to establish the association between the presence of lipohypertrophy and its associated risk factors, including years on injection, total injection in a day, total insulin unit per day, often change needle, insulin injection site and move to a different area.
METHODS: This cross-sectional study included 128 patients with type 2 diabetes mellitus who received insulin therapy in an outpatient diabetic clinic. Questionnaires on socio-demographic and lipohypertrophy-associated risk factors were distributed among patients, and lipohypertrophy-assessment was done using a checklist. Descriptive statistics and Pearson Chi-square were used for statistical analysis.
RESULTS: The prevalence of lipohypertrophy was 51.6% (95% CI: 42.6, 60.5). Swelling on fatty tissue (46.1%) exhibited the highest percentage of lipohypertrophy features during the assessment. Pearson Chi-Square revealed a significant relationship between the presence of LH and BMI categories (χ2 = 10.059, df = 3, p = 0.018), duration of injection (χ2 = 15.001, df = 3, p = 0.002), frequency of needle replacement (χ2 = 9.525, df = 3, p = 0.023) and rotation of injection site (χ2 = 5.914, df = 1, p = 0.015).
CONCLUSION: The high prevalence of lipohypertrophy indicates a need for a prevention strategy. Thus, nurses should play an important role in educating patients regarding the proper administration of insulin injections and performing a routine lipohypertrophy assessment and health education on the correct method of insulin injection.
Fulltext Dataset on nurses' knowledge, attitude and practice in pressure injury prevention at Sabah, Malaysia

Thomas DC, Nain RA

Data Brief, 2023 Jun;48:109193.
PMID: 37213558 DOI: 10.1016/j.dib.2023.109193

Pressure injuries are a significant problem in healthcare, and understanding the knowledge and practices of nurses in this area is critical to improving patient outcomes. This article presents dataset concerning a survey conducted to assess the knowledge, attitudes, and practices of pressure injury prevention and care among nurses in public hospitals in the West Coast division of Sabah, Malaysia. The study involved 448 nurses who completed a structured questionnaire between April and December 2021, using the Malay version of the Pieper-Zulkowski-Pressure Ulcer Knowledge Test (PZ-PUKT) 2016 questionnaire. The questionnaire included socio-demographic information and three outcome measures related to pressure injury prevention. Quantitative descriptive statistical analysis was used to analyze the survey results. The data suggest that this survey provides insights into nurses' knowledge, attitudes, and practices regarding pressure injury prevention and could inform the development of interventions to improve the prevention and management of pressure injuries in public hospitals.
Fulltext Prevalence of lipohypertrophy in insulin-treated type 2 diabetes mellitus. [Abstract]

Nain RA, Thomas DC, Hmwe NTT

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):5-0.
MyJurnal

1st UMS INTERNATIONAL NURSING CONFERENCE IN CONJUNCTION WITH 11TH INTERNATIONAL NURSING STUDENTS’ FORUM. A view into the future of nursing: Nursing Transformation towards IR-4.0; Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; On 6-8th March 2020
Introduction: Lipohypertrophy is one of the most common complications of insulin injection. Early detection of lipo- hypertrophy is very important to prevent the risk of hyperglycemia or hypoglycemia, arisen due to inconsistencies in absorption of insulin. The purpose of this study is to determine the prevalence of lipohyperthrophy in insulin-treated type 2 Diabetes Mellitus. Methods: This is a quantitative descriptive study which was carried out from June to August 2017 in one of tertiary hospital in Sabah. Participants were recruited via purposive convenience sampling. This study was divided into 2 parts which includes questionnaire survey and examination of lipohyperthrophy based on inspec- tion and palpation techniques. Study participants were patients with type 2 Diabetes Mellitus and on insulin injection more than 3 months. The finding of the injection site examination recorded as “presence” and “not presence” based on the features of lipohyperthrophy. The features of lipohyperthrophy include a palpable lump, swelling of fatty tissue around the subcutaneous insulin injection site, thickened ‘rubbery’ swelling of tissue that is soft and firm, and less pain sensation. Respondent who have one or more of these features considered as presence of lipohyperthrophy. Results: Out of 130 patients, more than half of respondents (51.5%, n=67) had lipohyperthrophy and 48.5% (n=63) without lipohyperthrophy. The occurrence of lipohyhertrophy is shown to be higher in patients who had a longer duration of insulin injection (p=0.002), Failure of changing needle (p=0.026) and failure of rotation injection site (p=0.017) at each time of injection. Conclusion: The high prevalence of lipohypertrophy shown in this study high- lights the need for prevention strategies, which include regular assessment for the presence of lipohypertrophy and health education on insulin injection. Health education should emphasize on self-assessment of lipohypertrophy, and the importance of right injection techniques.
Fulltext The role of debridement in wound bed preparation in chronic wound: A narrative review

Thomas DC, Tsu CL, Nain RA, Arsat N, Fun SS, Sahid Nik Lah NA

Ann Med Surg (Lond), 2021 Nov;71:102876.
PMID: 34745599 DOI: 10.1016/j.amsu.2021.102876

Objective: To provide an overview of the types of wound debridement and update the available scientific consensus on the effect of wound debridement.
Methods: The articles were searched through CINAHL, PubMed, Cochrane Library, and Medline database for relevant articles on all types of wound debridement. Articles included were all systematic review on the effectiveness of wound debridement-related outcome, published within the year 2017 until Aug 2021, in English.
Results: A total of seven scientific articles had been selected for review out of 318 screened. The authors reviewed a total of 318 titles and abstracts related to wound debridement effectiveness. Seven articles that were selected were narratively reviewed by two authors. The findings of the review were organized into autolytic, enzymatic, sharp, surgical, biological, and mechanical debridement methods and includes the advantages and disadvantages of each. The author further explored on the role of wound debridement according to wound bed preparation model. Articles were synthesized and organized based on the authors, year, total studies included in the systematic review, study range of year, total sample, debridement method, wound types, and findings.
Conclusion: Maggot debridement therapy showed a consistent finding in terms of effectiveness in debriding chronic wounds. The newer debridement method includes hydro-surgery, low-frequency ultrasonic and enzymatic collagenase debridement were getting more attention due to faster wound bed preparation and less painful. However, these newer method of debridements showed inconclusive findings and the patient safety was not clearly defined. A higher level of review is warranted in the future study.