The Economic Burden of Insulin Injection-Induced Lipohypertophy. Role of Education: The ISTERP-3 Study

Abstract

Introduction:The history of insulin-induced skin lipohypertrophy (LH) runs parallel to that of insulin's 100 years, and an average of 47% of insulin-treated patients still suffer from it today. The metabolic and economic effects of LH are significant, with hypoglycemia being the most striking. The objective of the study was to perform a 52-week follow-up of 713 insulin-treated patients with type 2 diabetes (T2DM) and LH to detect any differences in the occurrence of hypoglycemic events (HYPOs) and related healthcare costs as well as in LH rates and injection habits between an intensive education intervention group (IG) and control group (CG) provided with a single educational session at the starting point. Methods: All participants were trained in accurately self-monitoring blood glucose and recording all HYPOs for 6 months, which allowed baseline recordings before they were randomized into the IG, comprising 395 insulin-treated subjects undergoing repeated, structured multimodal education on correct injection techniques as a longstanding behavioral rehabilitation strategy, and the CG, AMD =

Exploratory study on glycemic control improvement for patients with diabetes mellitus by appropriate re-education on insulin self-injection technique during COVID-19 pandemic

“…The method of identifying LH requires a certain level of accuracy [22] , and the observation period of 6 months in this study is considered too short to verify the changes in LH brought about by re-education. There are detailed studies demonstrating improvements in LH and glycemic control [17] , [18] The continuous management of LH has been shown to contribute to risk reduction and improved cost-effectiveness during insulin treatment [19] . The number of LH confirmed by palpation was approximately 52% higher than that confirmed by visual inspection alone, indicating that palpation is more effective than visual inspection in detecting LH.…”

“…Rotation of the injection site is an important SIT element that prevents LH development [13] . As described so far, SIT is considered one of the factors influencing glycemic control, and improvement in glycemic control has been reported to be expected through re-education focusing on SIT [14] , [15] , [16] , [17] , [18] , [19] . It is important to verify such findings in countries with diverse racial groups and healthcare systems.…”

Why Do So Many People with Type 2 Diabetes Who Take Insulin Have Lipohypertrophy? Fate or Educational Deficiencies?

“…In patients starting in the hospital, the time interval between discharge and the time of enrollment ranged from 24 to 43 months. Our previous data on the durability of education concerning correct injection techniques did not exceed 6 months [ 29 , 30 , 40 ]. From this, it is clear that a therapeutic intervention, even if well performed, tends to be forgotten within a few months if not repeated and reinforced constantly.…”

Insulin-induced lipohypertrophy and factors affecting it in children and adolescents with type 1 diabetes mellitus: Review of the literature from the past 12 years: An appraisal and extension to adult subjects

“…For years our research group has published on IILH in different adult groups with T1DM and T2DM, including special populations such as older people (2) and those on dialysis (3)(4)(5)(6). We dealt with methodological (7)(8)(9)(10), epidemiological (11)(12)(13), pathophysiological (14), and educational (15,16) aspects and described metabolic consequences (11)(12)(13)(14)16), associated comorbidities, acute and chronic complications (17)(18)(19)(20), and costs (16,17) of IILH. Besides describing peculiar clinical cases (21,22), we commented on clinical trials and investigations from other groups (23)(24)(25)(26)(27)(28)(29)(30)(31)(32), produced recommendations and guidelines on correct injection technique implementation to avoid lipodystrophies (LD) and especially IILH (.9,33,34).…”

“…which represent consequences rather than causal factors of IILH (11,32). Fortunately, IILH lesions are reversible with adequate and repeated structured education on correct injection techniques (15)(16)(17).…”