The association between pharmacist-led medication counselling on proper priming, storage, and rotation of Penfill Mixtard insulin and the incidence of lipodystrophy

Background: Lipodystrophy (lipohypertrophy and lipoatrophy) is a common preventable adverse reaction to insulin therapy that impairs glycaemic control and increases healthcare costs. Proper pen priming, storage at room temperature, and systematic injection site rotation are essential components of safe insulin administration.
Objective: To determine whether pharmacist-led counselling on proper insulin injection techniques is associated with reduced incidence of lipodystrophy in patients using Penfill Mixtard insulin.
Methods: A retrospective cohort study was conducted at Talal Military Hospital, Jordan. Medical records of diabetic patients prescribed Penfill Mixtard insulin between January 2023 and December 2024 were reviewed. The intervention group (n=150) received structured pharmacist-led counselling on proper priming, storage, and site rotation. The control group (n=150) received routine medical care without specialised instruction. Lipodystrophy cases were identified from physician notes. Chi-square tests and binary logistic regression were used to adjust for confounding factors.
Results: Lipodystrophy incidence was 12.7% in the intervention group vs. 34.0% in the control group (p<0.001). Pharmacist-led counselling was identified as an independent protective factor (adjusted OR=0.28, 95% CI: 0.16–0.49, p<0.001). Longer insulin therapy duration (>5 years) and higher baseline HbA1c (≥9%) were associated with increased risk.
Conclusion: Pharmacist-led counselling on proper insulin injection technique significantly reduces lipodystrophy incidence. These findings highlight the important role of clinical pharmacists in patient education and chronic disease management.