Determination of insulin-related lipohypertrophy frequency and risk factors in patients with diabetes

• Published in: Endocrinología, diabetes y nutrición. diabetes y nutrición., 2022-05, Vol.69 (5), p.354-361
• Main Authors: Korkmaz, Fatma Nur, Gökçay Canpolat, Asena, Güllü, Sevim
• Format: Article
• Language: English
• Subjects: Diabetes mellitus; Ecografía; Insulin treatment; Lipohipertrofia; Lipohypertrophy; Tratamiento con insulina; Ultrasonography
• ISSN: 2530-0180; 2530-0180
• DOI: 10.1016/j.endien.2022.05.006

Insulin, which is used in the treatment of diabetes mellitus (DM), may lead to the development of lipohypertrophy (LH) which can negatively affect the management of diabetes mellitus. Two common methods to detect LH are palpation and superficial subcutaneous ultrasonography (SSU). We investigated the frequency of non-palpable LH using SSU, as well as examining risk factors. We included in our study patients who had been receiving insulin injections at least twice a day for over one year without palpable LH. The epidermis and the subcutaneous tissue thickness of each region were examined using SSU. The presence of LH and associated risk factors for LH were evaluated. We included 136 patients in our study. The mean age of all patients was 52.87±14.93 years, 59.6% were female and 73.5% had type 2 DM. The duration of DM and insulin usage were 15.76±9.20 and 11.42±8.26 years, respectively. The mean body mass index (BMI) of all patients was 30.59±7.40kg/m2. Non-palpable LH was detected in 87.5% (n=116) of the patients using SSU. In the multivariate logistic regression analyses, total cholesterol level, short-acting insulin dose and coronary artery disease (CAD) were associated with LH presence. Non-palpable LH can be seen at high rates in patients who have multiple insulin injections. Palpation is likely not enough to detect LH and we believe it would be appropriate to evaluate the presence of LH using SSU, especially for those who need high-dose insulin to control hyperglycaemia. La insulina, que se utiliza en el tratamiento de la diabetes mellitus (DM), puede provocar lipohipertrofia (LH), con efectos negativos en el control de la DM. La palpación y la ecografía subcutánea superficial son dos métodos habituales para la detección de la LH. Investigamos la frecuencia de LH no palpable mediante ecografía subcutánea superficial, además de examinar los factores de riesgo asociados a la misma. Incluimos en nuestro estudio a pacientes que habían estado recibiendo inyecciones de insulina al menos dos veces al día durante más de un año sin LH palpable. Se examinaron la epidermis y el grosor del tejido subcutáneo de cada región mediante ecografía subcutánea superficial. Se evaluaron la presencia de LH y los factores de riesgo asociados con la misma. Se incluyeron 136 pacientes en nuestro estudio. La media de edad de todos los pacientes fue de 52,87±14,93 años, el 59,6% eran mujeres y el 73,5% tenían DM de tipo 2. La duración de la DM y el uso de insulina fue de 15,76±9,