Expert Recommendations on Insulin Injection Technique and Education for the Pediatric and Young Adult Population with Diabetes: FITTER Forward Youth.

Rates of type 1 diabetes (T1D) and type 2 diabetes (T2D) in the pediatric population have risen over the past two decades. Insulin therapy remains critical for diabetes management, and proper injection technique has been shown to improve injection experience, glycemic management, and health outcomes. Youth with diabetes (YWD), ranging from infancy to young adulthood, require unique considerations for injection technique and education best practices due to their distinct physiological, developmental, emotional, psychological, and psychosocial needs relative to adults. Considering these needs, comprehensive recommendations addressing both physiological and behavioral health aspects of YWD are warranted. Nine pediatric diabetes specialists from five countries collaborated virtually to develop pediatric and young adult recommendations for proper injection technique updated from the adult-focused Forum for Injection Technique and Therapy Expert Recommendations (FITTER) Forward guidelines published in 2025. The resulting 'FITTER Forward Youth' recommendations address insulin initiation, injection technique, storage, injection method, and lipodystrophy. Psychosocial concerns for YWD and their caregivers, including diabetes distress, depressive symptoms, and anxiety, are also discussed. Additionally, technical and psychosocial education around insulin administration is key for YWD, their primary caregivers, and community-based secondary caregivers through daycare or school. Due to variable resources across geographical regions and socio-economic groups, FITTER Forward Youth also encompasses proper injection technique education for manual injection devices, which are typically more accessible than advanced diabetes technologies, such as insulin pumps and automated insulin delivery systems.