59-LB: Prevalence and Risk Factors of Lipohypertrophy and Lipoatrophy in Diabetes Patients Receiving Insulin Therapy

Abstract

Objectives: Insulin therapy is associated with skin-related complications, such as lipoatrophy, lipohypertrophy (LH), edema, and allergy. Lipohypertrophy (LH) is the most common cutaneous complication of injectable insulin therapy in the treatment of diabetes. Our aim in this study was to evaluate skin-related complications in diabetic patients receiving insulin therapy. Methods: In this study, diabetic patients who were treated with insulin therapy in Endocrinology Department between 2015 and 2018 were evaluated. Observation and palpation technique was used in the evaluation of lipohypertrophy in diabetic subjects. The degree of lipohypertrophy was classified as follows: grade 0 = no change; grade 1 = visible hypertrophy of fat tissue but with normal consistency on palpation; grade 2 = intensive fat tissue thickening but with firm consistency; and grade 3 = lipoatrophy Results: A total of 204 diabetic participants (52, 5 % female) were evaluated. The number of patients using insulin for more than 10 years was 81 (39,7%). The 4-mm needle was used more commonly in the study (54, 4 %). The recommended injection sites are the abdomen, thigh, arm and buttocks. Overall, 55, 9 % of patients were injecting insulin in the area of abdomen and 40, 2 % were injecting insulin four times per day. The ratio of the patients who do not change needle tip for each injection was 43,6%. In addition, lipohypertrophy was seen in 61, 8 % of the 204 diabetics in the study and most patients were revealed to have grade 1 (35,3%). Lipoatrophy was seen in 5.6% of the patients. Of the cases diagnosed as lipohypertrophy, 56, 3 % were women and 43,7% were men. Females were significantly more likely to have LH than males were (P = 0.042). Conclusions: Increased prevelance of lipohypertrophy is an important complication of insulin therapy and clinicians must be aware of this complication. Disclosure B. Aydin Buyruk: None. N. Kebapci: None. G. Yorulmaz: None. E. Alaguney: None. A. Akalin: None. B. Efe: None.

Insulin-Induced Skin Lipohypertrophy in Type 2 Diabetes: a Multicenter Regional Survey in Southern Italy

“…Also, as our patients only used insulin analogs, we could not compare LH rates associated with them to those associated with human regular, NPH, or premixed insulin preparations, which often were used instead, in studies published by other investigators. However, many studies found no significant differences among the types of insulin concerning the association with LHs [43][44][45][46][47][48].…”

The Insulin Receptor: An Important Target for the Development of Novel Medicines and Pesticides

“…The dramatic increase in T2DM over the globe has led to increasing requirements for insulin. Moreover, insulin injection may require more than one shot each day, is hazardous and inconvenient, causes tissue irritation, abscesses, discomfort, etc., and local allergic reactions, lipoatrophy, lipohypertrophy, etc., are common complications of subcutaneous injections [ 17 , 18 ]. Because of the multiple problems associated with insulin injection, orally active insulin-mimetic compounds would be an ideal substitute [ 19 ].…”

Lipohypertrophy prevalence and its associated risk factors in insulin-treated patients with type 2 diabetes in North Borneo, Malaysia

“…The side effect of insulin and injection-related tissue trauma is augmented by repeated subcutaneous insulin administration in a skin site resulting in LH, which is characterised by the formation of fatty lumps under the skin site of injection (Barola et al, 2018 ). This leads to decreased insulin absorption; as a result, the patient will show poor glycaemic control (Buyruk et al, 2019 ; Famulla et al, 2016 ). However, the frequency of episodes of unexplained hyperglycemia and severe hypoglycemia requiring assistance was higher in patients with LH (Arora et al, 2021 ).…”

“…Several studies have been conducted on patients with type 2 diabetes mellitus to determine the worldwide prevalence of LH (AlJaber et al, 2020 ; Buyruk et al, 2019 ; Deng et al, 2018 ; Ji et al, 2017 ; Rahim et al, 2020 ). It is reported that the pooled prevalence of LH was 38%, out of which type 2 diabetes mellitus and type 1 diabetes mellitus patients constitute 49% and 34%, respectively (Deng et al, 2018 ).…”

“…The association of LH with age, gender, period of therapy, body mass index, glycated haemoglobin, the total daily dose of insulin, insulin form, injection frequency, needle reuse, injection sites, and missed rotation sites has been investigated by several researchers (Barola et al, 2018 ; Buyruk et al, 2019 ; Calliari et al, 2018 ; Gorska-Ciebiada et al, 2020 ; Pozzuoli et al, 2018 ). Although these observations have made substantial contributions to the current body of knowledge, further studies are needed for several reasons.…”