Unexplained Hypoglycaemia and Large Glycaemic Variability: Skin Lipohypertrophy as a Predictive Sign

Strollo, Felice; Guarino, Giuseppina; Armentano, Vincenzo; Clemente, Gennaro; Martedì, Emilia; Riu, S. De; Gaeta, Iole; Corigliano, Gerardo; Ceriello, Antonio; Gentile, S

doi:10.17140/droj-2-126

Cited by 26 publications

(22 citation statements)

References 25 publications

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“…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]. Such criticism sounds like a defeat for clinicians.…”

Section: Discussionmentioning

confidence: 99%

Lipohypertrophy in Elderly Insulin-Treated Patients With Type 2 Diabetes

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Lipohypertrophy in Elderly Insulin-Treated Patients With Type 2 Diabetes

et al. 2020

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“…For instance, Patil et al found that “twenty-five (11.1%) subjects had noticed persistent swelling at their injection sites suggestive of the LH”, which in fact might not reflect actual LH presence [33]. Conversely, in a series of 387 people with T2DM [10], LH prevalence was as high as 77% according to a structured LH investigation method utilized by well-trained health professionals already successfully involved in LH-related studies [30, 31]. In addition to that, as pointed out by some authors, LH prevalence among studies may vary depending on lack of routine skin examination in diabetes clinics and/or on missed adherence to validated methods by poorly experienced health professionals [34, 35].…”

Section: Discussionmentioning

confidence: 99%

“…Another factor eventually contributing to HYPO and GV rate and adding to comorbidities typically found in dialyzed patients might be the presence of insulin-related skin lipohypertrophy (LH) [10–15]. Indeed LH has been shown to deteriorate both quality of life [11] and glycemic control [16, 17] despite increased insulin dosage [11], thus raising costs [30] as a result of higher acute/chronic complications and emergency room access rates [12, 18, 19].…”

Section: Introductionmentioning

confidence: 99%

Insulin-Related Lipohypertrophy in Hemodialyzed Diabetic People: a Multicenter Observational Study and a Methodological Approach

Gentile

Strollo²,

Satta³

et al. 2019

Diabetes Ther

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Introduction End-stage renal disease (ESRD) is associated with increased cardiovascular mortality (CVM) and diabetes mellitus (DM), which in many cases is treated with insulin. Skin lipohypertrophy (LH) very often occurs in insulin-treated (IT) patients as a consequence of inadequate injection technique and is one of the most prominent contributors to hypoglycemia (HYPO), glycemic variability (GV), and poor metabolic control (PMC). Method The aim of our multicenter observational study was to assess LH prevalence at self-injection sites and any possible factors predicting high LH/HYPO rates and GV in 296 dialyzed ITDM patients characterized by 64 ± 7 years of age, 7 ± 2 years disease duration, 2.6 ± 2.2 years dialysis duration, preferred pen utilization (80%), and basal-bolus regimen (87.4%) with self-injections (62.6%) largely surpassing caregiver-assisted ones (16.9%), and a mix of the two injection methods (20.5%). Results LH was detected in 57% of patients. Univariate analysis followed by backwards stepwise multivariate logistic regression function showed increased odds for developing LH in patients characterized by needle reuse, smaller injection areas, missed injection site rotation, higher HbA1c levels, and more prominent rates of HYPO and GV. Conclusion This was the first time such observation was made. It is now time for further studies aimed at providing evidence also in ESRD ITDM patients for the cause–effect relationship among wrong injection behavior, LH, and poor metabolic control and for the long-term preventative role of suitable educational countermeasures. Electronic supplementary material The online version of this article (10.1007/s13300-019-0650-2) contains supplementary material, which is available to authorized users.

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“…Therefore, it should be emphasized that suboptimal glycemic control and in patients with unexplained hypoglycemia, treating physicians should inspect and examine the presence of LH. 21 Repeated trauma to the same injection site when patients fail to rotate injections and/or repeated use of the same needle was reported worldwide. 5 The patient usually finds less painful injection when injected into LH area, and this could further aggravate the enlargement of LH area.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it should be emphasized that suboptimal glycemic control and in patients with unexplained hypoglycemia, treating physicians should inspect and examine the presence of LH. 21 …”

Section: Discussionmentioning

confidence: 99%

<p>Prevalence, Risk Factors, and Clinical Characteristics of Lipodystrophy in Insulin-Treated Patients with Diabetes: An Old Problem in a New Era of Modern Insulin</p>

Thewjitcharoen

Prasartkaew

Tongsumrit

et al. 2020

DMSO

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Background: Lipodystrophy has been reported as a common complication in insulin-treated patients, which could lead to unexplained hypoglycemia and suboptimal glycemic control. This study aimed to determine the prevalence, associated risk factors, and clinical characteristics of insulin-induced lipodystrophy in Thai patients. Patients and Methods: This was a cross-sectional study involving insulin-treated patients at Theptarin Hospital, one of the largest diabetes centers in Thailand. Results: A total of 400 patients were studied (female 53.5%, T2DM 86%, mean age 65.6 ±15.4 years, duration of diabetes 23.0±10.2 years, median insulin treatment 10 years, usage of insulin analog 72.1%, A1C 7.9±1.6%). The prevalence of lipohypertrophy (LH) in overall patients was 37.3% (T1DM 46.4% and T2DM 35.8%). The highest prevalence (57.5%) was observed in long-standing (≥10 years) T1DM patients. Multivariate analysis revealed that the duration of insulin use (≥10 years), use of human insulin, and incorrect rotation of injection sites were associated with LH. Patients with LH were found to have 7-times greater risk of unexplained hypoglycemia when compared with patients without LH. Lipoatrophy (LA) was found in only four cases (1.0%). All LA cases had a concurrence palpable area of LH. Conclusion: Insulin-induced lipodystrophy is still an overlooked complication in the conundrum of diabetes care. The presence of lipodystrophy was significantly associated with the occurrence of unexplained hypoglycemia. It should be emphasized to recognize this condition by inspecting and palpating insulin injecting sites regularly, and educate patients to avoid the development of lipodystrophy.

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Unexplained Hypoglycaemia and Large Glycaemic Variability: Skin Lipohypertrophy as a Predictive Sign

Abstract: Strollo F, Guarino G, Armentano V, et al on behalf of AMD-OSDI Italian Study Group on Injection Techniques. Unexplained hypoglycaemia and large glycaemic variability: Skin lipohypertrophy as a predictive sign.

Cited by 26 publications

References 25 publications

Lipohypertrophy in Elderly Insulin-Treated Patients With Type 2 Diabetes

Lipohypertrophy in Elderly Insulin-Treated Patients With Type 2 Diabetes

Insulin-Related Lipohypertrophy in Hemodialyzed Diabetic People: a Multicenter Observational Study and a Methodological Approach

<p>Prevalence, Risk Factors, and Clinical Characteristics of Lipodystrophy in Insulin-Treated Patients with Diabetes: An Old Problem in a New Era of Modern Insulin</p>

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