Recent Advances in Insulin Injection Technique: The 2025 FITTER Forward Recommendations

Following discussions at the 2015 Forum for Injection Technique and Therapy Expert Recommendations (FITTER) workshop held in Rome, international recommendations on insulin injection technique were published in 2016. To reflect the recent expansion of non-insulin injectable agents and the accumulation of new evidence, a revised edition—the FITTER Forward recommendations—was published in 2025. This review compares the 2016 and 2025 recommendations across domains to clarify the specific changes. It also summarizes seven key aspects of insulin injection education applicable to clinical practice: selection of injection devices; use of the recommended 4-mm, 32-gauge needle; rotation of injection sites; selfexamination for lipohypertrophy; avoidance of needle reuse; patient-centered education; and ongoing reassessment. The Korean Association of Diabetes Nurse Educators (KADNE) recently published the 3rd edition of its “Insulin Injection Technique Guidelines for Diabetes Educators”, incorporating these updates. By clearly understanding the changes in both international recommendations and domestic guidelines, diabetes educators can provide repeated, individualized education tailored to each patient, thereby enhancing the safety and effectiveness of insulin therapy.