Insulin-induced Lipohypertrophy in Patients with Type 1 Diabetes Mellitus Treated with an Insulin Pump

Abstract

Background. Lipohypertrophy (LH) of subcutaneous tissue is an insulin-induced complication occurring in patients with diabetes. We aimed to define the prevalence of LH and identify its risk factors in type 1 diabetes (T1DM) patients treated with continuous subcutaneous insulin infusion (CSII). Materials and Methods. The study included 79 consecutive CSII-treated T1DM patients. The diagnose of LH was based on ultrasonography (US) as a reference method, physical examination was also performed. Clinical characteristics were available from the medical records. Results. The median age of patients was 28 years (interquartile range [IQR], 24–30.5) with a body mass index (BMI) of 24.5 ± 3.5 kg/m2, HbA1c 7.1% (IQR, 6.7–8.1), T1DM duration 15 (9–20) years, and CSII use duration of 8 year (IQR, 5–11). LH was detected by US in 75 (94.9%) patients. This value was much higher than this obtained by visual assessment (n = 39, 49.4%) or palpation (n = 59, 74.7%). In univariate analyses, the following risk factors for occurrence of 5 and more LH lesions were identified: the ratio of insulin dose to body mass exceeding 0.7 IU/kg (OR, 3.69; 95% CI, 1.43–10.01) and the total daily insulin dose (OR, 1.05; 95% CI, 1.02–1.09). A higher dose of insulin per kg remained a significant risk factor of LH amount in multivariate analysis. Conclusion. This selected T1DM cohort treated with CSII had a very high prevalence of LH. US assessment should be considered as a reference method for LH screening in T1DM patients. The identified risk factors for the number of LH lesions were related to insulin dosing.

Habits related to the use of insulin infusion set in patients with type 1 diabetes on pump therapy — the effect of the educational intervention

“…In a pediatric patient group with T1DM no association between LH and a frequency of changing IISs was demonstrated [22]. In our previous report of this studied cohort of adult T1DM patients treated with insulin pumps, we did not notice that changing infusion sets less frequently than 3 days was a risk factor for the number of LH lesions [30]. This issue needs further investigation.…”

A Hypothesis on the Progression of Insulin-Induced Lipohypertrophy: An Integrated Result of High-Frequency Ultrasound Imaging and Blood Glucose Control of Patients

“…Demir G [22] graded LH from 0 to 3 according to the inspection and palpation of the insulin injection site. Considering the limitations of LH severity assessment based only on the number of lesions, Ucieklak D [23] proposed a new LH severity scale considering both the number and size of LH lesions and categorized LH into four stages of advancement. Additionally, Hashem R [24] proposed a conceptual model of an LH grading system.…”

Lipohypertrophy and Insulin: An Update From the Diabetes Technology Society

“…Research has shown that educating both HCPs and PWDs on ways to prevent LH is worth the effort. 9,16 In summary, five practices to decrease the risk of developing LH need to be considered. Individuals injecting insulin should 1.…”

“…Research has shown that educating both HCPs and PWDs on ways to prevent LH is worth the effort. 9,16…”

“…9 The disparity between the prevalence of perceived LH and clinically diagnosed LH demonstrates a lack of awareness and different diagnostic methods used by health care professionals (HCPs). Using visual inspection and palpation, the method most often used by the majority of HCPs, 37% to 64% of individuals screened appear to have LH [10][11][12][13][14][15][16][17][18][19][20] with some variation in how systematically the inspection is performed. 2,21 Ultrasound is a useful tool in LH detection because of its ability to reveal structural changes in deeper levels of SC tissue before there are any visual changes on the surface.…”