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

Abstract

Introduction: Lipohypertrophies (LHs) due to incorrect insulin injection techniques have been described in the literature for decades. Their rate averages 38%, but this is still controversial because of the vast range reported by different publications, most of which fail to describe the selected detection protocol and therefore are not entirely reliable. We still need to identify the real LH rate, and only consistently using a standardized method in a large cohort of insulin-treated (IT) patients make this possible.

Lipohypertrophy in Elderly Insulin-Treated Patients With Type 2 Diabetes

“…A large body of evidence suggests that LHs are invariably associated with needle reuse and failure to rotate injection sites and are more frequent in subjects with longer diabetes duration, especially females. There is also considerable agreement in the literature regarding a strong association between LH and high SH or NSH rates, large GV, and worse HbA1c [5,7,8,[14][15][16], but not with high insulin doses. Although our results support the findings from the majority of these published reports, we found that the injection of cold insulin occurred in about 50% of patients independently of age and that it was significantly associated with rate of LHs, as if the cryo-traumas per se functioned as an add-on to repeated mechanical trauma in terms of LH-related factors.…”

“…Consequently, in past publications we have also criticized research groups unable to adopt a strict, repeatable, and safe LH identification method [8,10,11]. Even more, we have pronounced the high prevalence of LH lesions as evidence that clinicians are not sufficiently interested in this problem and have allowed patients to carry out their insulin treatment in a non-systematic and somewhat careless manner [30,31].…”

“…Glycemic variability (GV) was evaluated by considering the mean [5] of glycemic fluctuations occurring over the observation period, when patients monitored capillary blood glucose both immediately before and 2 h after breakfast, lunch, and dinner, and at midnight, as reported elsewhere [14]. In the absence of any user-friendly, unanimously accepted clinical method, we investigated GV through a validated questionnaire [15] and defined it as high in the case of blood glucose levels swinging consistently, inexplicably, and unpredictably from \ 60 to [ 250 mg/dl at least once a week over the 3 months immediately preceding enrollment and for least for 3 weeks within the first and second trimester of the study, as previously described [5,8,15]. We identified LHs at all injection sites according to a validated clinical method described elsewhere [8,10,11].…”

“…In the absence of any user-friendly, unanimously accepted clinical method, we investigated GV through a validated questionnaire [15] and defined it as high in the case of blood glucose levels swinging consistently, inexplicably, and unpredictably from \ 60 to [ 250 mg/dl at least once a week over the 3 months immediately preceding enrollment and for least for 3 weeks within the first and second trimester of the study, as previously described [5,8,15]. We identified LHs at all injection sites according to a validated clinical method described elsewhere [8,10,11]. Briefly, a welltrained staff with [ 3 years of experience carefully followed a clearly defined patient inspection procedure with the patient in the supine, sitting, and standing position, both from the front and from the side.…”

“…This study is a sub-analysis of data collected in a multicenter survey [ 8 ] conducted by eight Italian outpatient diabetes units (DCs) that share electronic record systems, diagnostic–therapeutic procedures, and operating standards, and participate in the continuous care improvement program of the National Clinical Diabetology Association (AMD) ( https://www.aemmedi.it ). The specialists participating in the study had undergone full training on all procedures described in the study.…”