Insulin therapy waste produced in the households of people with diabetes monitored in Primary Care

Cunha, Gilmara Holanda da; Barbosa, Raiza Verônica Almeida; Fontenele, Marina Soares Monteiro; Lima, Maria Amanda Correia; Franco, Katia Barbosa; Fechine, Francisco Vagnaldo

doi:10.1590/0034-7167-2016-0406

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RESEARCH • Rev. Bras. Enferm. 70 (3) • May-Jun 2017 • https://doi.org/10.1590/0034-7167-2016-0406 copy

Insulin therapy waste produced in the households of people with diabetes monitored in Primary Care

Los residuos de la terapia con insulina en las viviendas de personas con diabetes asistidas en atención primaria

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the insulin therapy waste disposal produced in the households of people with diabetes mellitus (DM).

Method:

Cross-sectional study with 105 Primary Care patients. Socio-demographic and clinical variables and insulin therapy practice were analyzed through the absolute and relative frequencies, Fisher's exact test and prevalence ratio (PR).

Results:

The association between types of insulin (60.0%), administered with a disposable syringe attached to a needle (80.9%), and a high percentage of reuse and disposal in normal household waste (57.1%) stood out. The professionals who most frequently provided guidance to people with diabetes were the nurses. Patients who had received instructions about disposal were 21 times more likely to dispose of waste properly than those who had not (PR 21.5; P < 0.0001). Age, gender, skin color, education, marital status, occupational status and type of DM did not interfere in the disposal (P > 0.05).

Conclusion: People with diabetes served in Primary Health Care require guidance and material resources to carry out the appropriate disposal of insulin therapy waste.

Descriptors:
Diabetes Mellitus; Insulin; Disposal of Health Services Residues; Nursing; Health Promotion

Clinical and sociodemographic variables	n	%
Age group (years)
≤ 29	7	6.7
30-39	3	2.9
40-49	10	9.5
> 50	85	80.9
Gender
Male	35	33.3
Female	70	66.7
Self-reported skin color
White	33	31.4
Mixed	72	68.6
Education level (years)
Illiterate	22	20.9
< 8 years	39	37.1
≥ 8 years	44	42.0
Marital status
Single	21	20.0
Married/Common-law marriage	58	55.2
Widowed/divorced/separated	26	24.8
Position of the person with diabetes in the family
Father	26	24.8
Mother	64	60.9
Son	15	14.3
Occupational situation
Employee	22	20.9
Unemployed	10	9.6
Retiree	57	54.3
Housewife	16	15.2
Type of diabetes mellitus
Diabetes mellitus type 1	13	12.4
Diabetes mellitus type 2	92	87.6
Time of diagnosis (in years)
0-9	35	33.3
> 10	70	66.7
Comorbidities associated with diabetes
Does not have comorbidities	58	55.2
Diabetic foot	16	15.3
Retinopathy	33	31.4
Nephropathy	7	6.7
Cardiovascular diseases	18	17.1

Characteristics of insulin therapy practice	n	%
Insulin type
Neutral Protamine Hagedorn (NPH)	24	22.9
Regular and Neutral Protamine Hagedorn (NPH)	63	60.0
Others	18	17.1
Amount of needles and syringes used per month
Does not use a syringe	16	15.3
1-10	14	13.3
11-20	31	29.5
21-30	35	33.3
> 30	9	8.6
Amount of pens used per month
Does not use a pen	88	83.8
1-5	3	2.9
5-10	14	13.3
Syringe type used in the application of insulin
Does not use a syringe due to using a pen instead	16	15.3
Disposable syringe attached to the needle	85	80.9
Disposable syringe not attached to the needle	4	3.8
Capillary blood glucose verifying at one’s own house
Yes	97	92.4
No	8	7.6
Frequency of capillary blood glucose verifying
Not often	4	3.8
Once a day	19	18.1
Twice a day	16	15.2
Thrice a day	17	16.2
More than three times a day	11	10.5
Once per week	21	20.0
Two times a week	6	5.7
Three times a week	7	6.7
More than three times a week	4	3.8
Number of insulin uses per day
1	15	14.2
2	36	34.3
3	30	28.6
4	24	22.9
Re-use of disposable syringe
Does not use a syringe, but a pen	16	15.3
Yes	83	79.0
No	6	5.7
Re-use of disposable needle
Yes	98	93.3
No	7	6.7

Destination of insulin therapy waste	n	%
Guidance on disposal of waste from glucose/insulin
administration
Yes	51	48.6
No	54	51.4
Disposal of syringes, needles and lancets after use
Does not use a syringe	16	15.3
In a hard and durable container	6	5.7
Polyethylene terephthalate bottle (PET)	17	16.2
Household waste	60	57.1
Others	6	5.7
Disposal of reagent strips after use
Does not use them	4	3.8
In a hard and durable container	4	3.8
Polyethylene terephthalate bottle (PET)	17	16.2
Household waste	76	72.4
Others	4	3.8
Disposal of empty insulin bottle after use
Does not use them	16	15.3
Adequate container for sharp materials	1	0.9
In a hard and durable container	3	2.8
Polyethylene terephthalate bottle (PET)	9	8.6
Household waste	70	66.7
Others	6	5.7
Disposal of cotton after use
Does not use them	1	0.9
In a hard and durable container	3	2.9
Polyethylene terephthalate bottle (PET)	8	7.6
Household waste	91	86.7
Others	2	1.9
Disposal of pens after use
Does not use a pen	87	82.9
Polyethylene terephthalate bottle (PET)	2	1.9
Household waste	15	14.3
Others	1	0.9
Destination of the container for disposal when it is full Material delivered in the health unit	14	13.3
Material placed for garbage collection, but separated from household waste	24	22.9
Material does not have its own container and is treated like common waste	67	63.8
Accident involving sharp materials with the household residents
Yes	3	2.9
No	102	97.1

Disposal of the waste	Guidance on the disposal				Prevalence Ratio (95% confidence interval)	p value (Fisher’s Test)
	Yes		No
	n	%	n	%
Syringes and needles
Correct	22	48.8	1	2.2	21.51	< 0.0001
Incorrect	23	51.1	43	97.7	(3.03-152.86)
Lancets
Correct	21	42.0	0	0.0	-	< 0.0001
Incorrect	29	58.0	51	100.0
Reagent tapes
Correct	21	42.0	0	0.0	-	< 0.0001
Incorrect	29	58.0	51	100.0
Insulin vials
Correct	12	26.6	1	2.2	11.73	0.0017
Incorrect	33	73.3	43	97.7	(1.59-86.50)
Cotton
Correct	11	21.5	0	0.0	-	0.0002
Incorrect	40	78.4	53	100.0
Pens
Correct	2	28.5	0	0.0	-	0.1373
Incorrect	5	71.4	11	100.0
Disposal container
Correct	14	27.4	0	0.0	-	< 0.0001
Incorrect	37	72.5	54	100.0
Accidents with the material
Yes	1	1.9	2	3.7	0.53	< 0.0001
No	50	98.0	52	96.3	(0.05-5.67)

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[1] CORRESPONDING AUTHOR: Gilmara Holanda da Cunha. E-mail: gilmaraholandaufc@yahoo.com.br