LETTER TO THE EDITOR
KNOWLEDGE AMONG OLDER ADULTS AND INFORMAL CAREGIVERS ABOUT INSULIN THERAPY: CHALLENGES AND STRATEGIES FOR SELF-MANAGEMENT
CONOCIMIENTO DE LAS PERSONAS MAYORES Y DE LOS CUIDADORES INFORMALES SOBRE LA INSULINOTERAPIA: DESAFÍOS Y ESTRATEGIAS PARA EL AUTOCONTROL
CONHECIMENTO DE IDOSOS E CUIDADORES INFORMAIS SOBRE INSULINOTERAPIA: DESAFIOS E ESTRATÉGIAS PARA AUTOGESTÃO
https://doi.org/10.31011/reaid-2026-v.100-n.1-art.2708
1Vitória Tonsica Marcato
2Heloiza Matos de Oliveira
3Breno da Silva Oliveira
4Daniel de Macêdo Rocha
1Universidade Federal de Mato Grosso do Sul, Coxim, Brazil. ORCID: 0009-0002-4748-1537
2Universidade Federal de Mato Grosso do Sul, Coxim, Brazil. ORCID: 0009-0000-0172-8261
3Universidade Federal de Mato Grosso do Sul, Coxim, Brazil. ORCID: 0009-0008-0950-2951
4Universidade Federal de Mato Grosso do Sul, Coxim, Brazil. ORCID: 0000-0003-1709-2143
Corresponding Author
Daniel de Macêdo Rocha
General Mendes de Moraes, 369, Jardim Novo Mato Grosso, Coxim, Mato Grosso do Sul, Brazil. CEP: 7940000, Phone: +55(16) 99256-0204, E-mail: daniel.macedo@ufms.br.
Submission: 15-12-2025
Approval: 18-12-2025
Dear Editor,
Population aging and the epidemiological transition pose a challenge to the Unified Health System (UHS) in managing complex chronic conditions, with Diabetes Mellitus (DM) taking center stage. However, more than the high prevalence of the disease, the gap in competence, knowledge, and skills for self-care at home, as well as for self-management of treatment, has sparked extensive discussions in the scientific, political, and healthcare fields(1).
Among therapeutic alternatives, insulin therapy is a common resource, often indispensable for metabolic control. It is a highly complex intervention that, when associated with the functional and cognitive decline inherent in senescence, creates a high-risk scenario for serious adverse events, complications, and hospitalizations, which are mostly avoidable(1,2).
In this context, it is observed that the responsibility for administering insulin is often shared with informal caregivers who, although essential, rarely possess the necessary health knowledge or technical training. The literature points out that the effectiveness of insulin therapy depends not only on the pharmacological prescription, but also on self-management, which involves everything from correct storage and application technique to clinical reasoning for dose adjustments and recognition of signs of decompensation(3,4). When older adults lose autonomy, and the caregiver is not trained, the patient's safety in the home setting is frequently compromised.
It is therefore essential to problematize the role of Nursing in Primary Health Care (PHC). Although PHC is the organizer of care, educational strategies remain fragmented or excessively normative. The simple delivery of supplies or quick verbal instructions in the office proves insufficient to guarantee adherence and the correct administration technique(4-6). Health education for older adults and caregivers requires active methodologies, such as simulation, demonstration, and continuous monitoring, considering the sensory, educational, and cognitive limitations of this population, as well as the lack of technical and scientific preparedness of their support networks.
In light of the above, it is argued that competence in insulin management should not be presumed, but rather evaluated and certified periodically by the Nursing team, given that gaps in knowledge about insulin therapy represent a direct determinant of unfavorable clinical outcomes.
Thus, strengthening patient safety in insulin use requires a paradigm shift: the transition from a prescription-centered model of care to one focused on the continuous training of the older person–caregiver dyad. Reflections on the leading role of Nursing in this process are necessary, considering its potential for implementing structured and longitudinal educational interventions that transform technical information into safe, effective, sustainable, and evidence-based practical skills to reduce the gaps between disease complexity and the capacity for treatment self-management.
REFERENCES
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2 Muzy J, Campos MR, Emmerick I, Silva RSD, Schramm JMA. Prevalence of diabetes mellitus and its complications and characterization of healthcare gaps based on triangulation of studies. Cad Saude Publica. 2021 May 28;37(5):e00076120. Doi: https://doi.org/10.1590/0102-311X00076120
3 Underwood PC, Ruscitti B, Nguyen T, Magny-Normilus C, Wentzell K, Watts SA, Bowser D. A Health Systems Approach to Nurse-Led Implementation of Diabetes Prevention and Management in Vulnerable Populations. Health Syst Reform. 2025 Dec 31;11(1):2503648. Doi: https://doi.org/10.1080/23288604.2025.2503648
4 Cunha GHD, Fontenele MSM, Siqueira LR, Lima MAC, Gomes MEC, Ramalho AKL. Insulin therapy practice performed by people with diabetes in Primary Healthcare. Rev Esc Enferm USP. 2020 Oct 12;54:e03620. Doi: https://doi.org/10.1590/S1980-220X2019002903620
5 Mohamad Yusaini NSN, Akkawi ME. The association between diabetes knowledge, treatment satisfaction and medication adherence among Malaysian geriatric patients. Diabetol Int. 2025 Nov 25;17(1):5. Doi: https://doi.org/10.1007/s13340-025-00860-8
6 Yang YM, Chan HY, Ho YF, Lin HW, Wang CC, Wang T, Huang YM. Charting the path to better diabetes outcomes: Revealing psychosocial influences on medication adherence through the information-motivation-behavioral skills model among adults with type 2 diabetes. Res Social Adm Pharm. 2026 Jan;22(1):96-106. Doi: https://doi.org/10.1016/j.sapharm.2025.08.010
Funding:
This research received no funding.
Authorship criteria (author contributions)
All authors participated in the conception of the study, as well as in the writing, critical review, and final approval of the published version.
Conflict of Interest Statement
Nothing to declare.
Scientific Editor: Ítalo Arão Pereira Ribeiro. Orcid: https://orcid.org/0000-0003-0778-1447
Rev Enferm Atual In Derme 2026;100(1): e026011
Atribuição
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