Lipoatrophy: re‐emerging with analogue insulins. Is there a link with CSII?

Abstract

Over the last decade, there has been an increase in reported cases of lipoatrophy as a complication of treatment with analogue insulin preparations. Lipoatrophy causes undesirable cosmetic appearances and may cause variable glycaemic control. We report a case series of four female patients from a tertiary paediatric diabetes unit presenting with lipoatrophy while on treatment with insulin aspart via a continuous subcutaneous insulin infusion (CSII) pump for the management of type 1 diabetes. We did not observe any cases of lipoatrophy in patients receiving multiple daily insulin injections. In examining the effect of lipoatrophy on glycaemic control, we found no detrimental effect of lipoatrophy on the patients’ glycated haemoglobin. Cases of lipoatrophy should be reported to drug manufacturers and through the appropriate national adverse drug reaction reporting system. This will facilitate observation of trend, and help monitor for associations, informing future research.

Detemir plus aspart and glulisine induced lipoatrophy: 2015 literature review and report of a new case

“…One of the detemir cases [4], one of the aspart cases [6] and one of the NovoMix30 cases [8] were previously described in the 2009 literature review [9], giving 30 new cases since then: 4 detemir cases [10, 11], 20 aspart cases [10, 12–22], 2 NovoMix 30 [10], and 4 detemir plus aspart cases [11, 23, 24]. The characteristics of the 33 cases are:…”

“…Did not resolve spontaneously. Biopsy findingsSimeonovic M et al UK and Australia 2014 [22]3 yo girl with T1DM developed LA at Asp infusion site (buttock) when on CSII (after 1-3 yrs).Simeonovic M et al UK and Australia 2014 [22]7 yo girl with T1DM developed LA at Asp infusion site (abdomen) when on CSII (1-3 yrs later).Simeonovic M et al UK and Australia 2014 [22]8 yo girl with T1DM developed LA at Asp infusion site (thigh) when on CSII (after 1-3 yrs).Simeonovic M et al UK and Australia 2014 [22]10 yo girl with T1DM developed LA at Asp infusion site (abdomen) when on CSII (after 1-3 yrs).Saberi et al USA 2014 (our report)41 yo T1DM woman developed LA at injection sites on thighs, upper arms and abdomen 14 months after starting aspart and detemir MDI. When switched to CSII (Omnipod) using aspart LA developed within a year.…”

“…The 33 lipoatrophy cases are induced by detemir (n = 5) [ 4 , 10 , 11 ], aspart (n = 21) [ 6 , 10 , 12 – 22 ], detemir plus aspart (n = 4) [ 11 , 23 , 24 ], and NovoMix 30 (n = 3) [ 8 , 10 ] injections (Table 1 ). One of the detemir cases [ 4 ], one of the aspart cases [ 6 ] and one of the NovoMix30 cases [ 8 ] were previously described in the 2009 literature review [ 9 ], giving 30 new cases since then: 4 detemir cases [ 10 , 11 ], 20 aspart cases [ 10 , 12 – 22 ], 2 NovoMix 30 [ 10 ], and 4 detemir plus aspart cases [ 11 , 23 , 24 ]. The characteristics of the 33 cases are:…”

“…Did not resolve spontaneously. Biopsy findings Simeonovic M et al UK and Australia 2014 [ 22 ] 3 yo girl with T1DM developed LA at Asp infusion site (buttock) when on CSII (after 1-3 yrs). Simeonovic M et al UK and Australia 2014 [ 22 ] 7 yo girl with T1DM developed LA at Asp infusion site (abdomen) when on CSII (1-3 yrs later).…”

“…However, in our literature review, 18 of the 21 cases of lipoatrophy induced by aspart were associated with CSII which has been hypothesized to contribute to the development of lipoatrophy [22]. Why the largest increase in aspart-induced lipoatrophy occurred in those on CSII remains unclear.…”