Lipohypertrophy: does it matter in daily life? A study using a continuous glucose monitoring system

Overland, Jane; Molyneaux, Lynda; Tewari, Sujata; Fatouros, R.; Melville, P.; Foote, Deborah; Wu, Ted; Yue, Dennis K.

doi:10.1111/j.1463-1326.2008.00972.x

Cited by 24 publications

(9 citation statements)

References 10 publications

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“…It was concluded by Overland J, et al, [8] that "the pharmacokinetic and pharmacodynamic effect of injecting into lipohypertrophic tissue is small in comparison to the usual clinical variation observed with insulin injections as there was no difference in continuous glucose monitoring (CGMS) profiles between areas with lipohypertrophy and areas without lipohypertrophy. Therefore, the exact effect of lipohypertrophy is still not clear.…”

Section: Discussionmentioning

confidence: 99%

Lipohypertrophy in children and adolescents with type 1 diabetes and the associated factors

2011

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BackgroundDespite the important implications of lipohypertrophy for diabetes control, there is a dearth of information and research about the subject in children. The aim of this study was to study the prevalence of lipohypertrophy in children with type 1 diabetes, and to evaluate the associated factors.Findings119 children coming for regular follow up in the diabetes clinic were examined for the presence of lipohypertrophy by inspection and palpation. The last 4 readings of glycated hemoglobin (HbA1c) levels and other factors that may affect lipohypertrophy were documented. RESULTS: The patient's age ranged from 2 months to 21 years with a median of 10 years (inter-quartile range = 6). Lipohypertrophy occurred in 54.9% of patients, more commonly in males (62.7%) vs. females (48.4%) (P = 0.074). Grade 1 lipohypertrophy occurred in 42.5% and grade 2 in 12.4%. Lipohypertrophy was related significantly to the dose of insulin units per kg of body weight (Odds ratio [OR] = 16.4; 95% CI, 2.2 - 124.6; P = 0.007), the duration of diabetes, [OR] = 1.16; 95% CI, 1.05 - 1.32; P = 0.004)), and the body mass index (BMI) [OR] = 1.68; 95% CI, 1.25 - 2.15; P = 0.006). The mean HbA1c levels of patients with grade 1 and grade 2 lipohypertrophy did not differ from diabetics without lipohypertrophy (F = 0.178, P = 0.837)ConclusionsThe presence of lipohypertrophy was significantly associated with the duration of diabetes and the body mass index. Children with lipohypertrophy needed a significantly higher dose of insulin units/kg of body weight to achieve fair control compared to children without lipohypertrophy. Further studies are needed to ascertain the clinical meaning of these findings.

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Section: Discussionmentioning

confidence: 99%

Lipohypertrophy in children and adolescents with type 1 diabetes and the associated factors

2011

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“…[7] LH retards insulin absorption significantly and to a sufficient magnitude to have an adverse effect on diabetes control. [8] Proper rotation of injection site and avoidance of needle reuse can prevent LH, or reduce its size which in turn improves glucose control. [4]…”

Section: Introductionmentioning

confidence: 99%

An audit of insulin usage and insulin injection practices in a large Indian cohort

Baruah

Kalra

Bose

et al. 2017

Indian J Endocr Metab

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Introduction:Insulin remains the cornerstone of therapy in a substantial number of patients with type 2 diabetes mellitus (T2DM). Inadequate knowledge regarding insulin usage is likely to influence its acceptance and adherence, and outcome of therapy, underscoring great need to investigate knowledge, attitude, and practice of insulin usage in patients with T2DM.Methodology:A cross-sectional registry-based retrospective study analyzed data collected from 748 respondents (male: 466, female: 282), mostly from high or middle economic status, who were enrolled as outpatient in a referral clinic during last 10 years (2006–2016), to assess the general characteristics of patients with type 2 diabetes and their baseline knowledge, attitude, and practice of insulin usage and injection practices.Results:Mean ± standard deviation (SD) of duration of diabetes was 12.24 ± 7.60 years and mean ± SD duration of insulin therapy was 3.42 ± 4.18 years, which was initiated after a mean ± SD diabetes duration of 8.80 ± 6.42 years. Mean insulin dose per kilogram of body weight/day was 0.51 ± 0.27 units. Total daily dose of insulin was 33.36 ± 18.44 units and number of injections/day (mean ± SD) was 2.06 ± 0.73. Among the respondents, 58.96% were on human insulin and 35.70% were on analog insulin. Pen devices were used by 66.08% of the population whereas 31.76% used insulin syringes. The prevalence of lipohypertrophy (LH) was 12.57%, which was significantly (P < 0.001) associated with wrong technique with regard to injection angle (10.45% vs. 23.02%), site of injection (7.00% vs. 30.51%), rotation of site of injection (0.88% vs. 17.66%), and reuse of needle (5.77% vs. 15.19%). LH was also significantly (P < 0.05) associated with the use of human (14.74%) compared to analog insulin (8.24%).Conclusion:The current study highlights the unique patterns of insulin usage and associated high prevalence of LH among insulin users in India.

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“…Blanco et al (4) observed significantly higher insulin dosing in patients with, versus those without, LHT, but did not report A1C levels. On the other hand, no differences were found in diabetes control or insulin demands between patients with and without LHT in one cross-sectional study (2), and an outpatient 3-day study with continuous glucose monitoring failed to show any substantial differences in insulin pharmacokinetics (PK) and BG profiles (7), so those authors felt it unnecessary to advise patients to avoid LHT for insulin injections. In addition, two meal studies with pharmacodynamic (PD) and PK comparisons of insulin injection into LHT versus normal adipose tissue (NAT) showed inconsistent results.…”

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confidence: 96%

Insulin Injection Into Lipohypertrophic Tissue: Blunted and More Variable Insulin Absorption and Action and Impaired Postprandial Glucose Control

et al. 2016

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Lipohypertrophy: does it matter in daily life? A study using a continuous glucose monitoring system

Abstract: The pharmacokinetic and pharmacodynamic effect of injecting into lipohypertrophic tissue is small in comparison to the usual clinical variation observed with insulin injections.

Cited by 24 publications

References 10 publications

Lipohypertrophy in children and adolescents with type 1 diabetes and the associated factors

Lipohypertrophy in children and adolescents with type 1 diabetes and the associated factors

An audit of insulin usage and insulin injection practices in a large Indian cohort

Insulin Injection Into Lipohypertrophic Tissue: Blunted and More Variable Insulin Absorption and Action and Impaired Postprandial Glucose Control

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