Frequency of Lipohypertrophy and Associated Risk Factors in Young Patients with Type 1 Diabetes: A Cross-Sectional Study

Abstract

IntroductionThe objective of this study was to investigate the frequency of lipohypertrophy (LH) and the associated risk factors in young patients with type 1 diabetes mellitus (T1DM).MethodsThis cross-sectional study was conducted on a sample of 174 patients with T1DM (aged 13–18 years) treated with multiple daily insulin injections for a minimum duration of 1 year. The study was performed at the Diabetes Treatment Center, Prince Sultan Military Medical City (Riyadh, Saudi Arabia), between July 2015 and September 2015. Information regarding patients’ age, weight, height, adjusted body mass index (BMI), period of the diabetic condition, length of needle used, number of injections per day, injection locations, insulin regimen, and glycosylated hemoglobin (HbA1c) were recorded. LH was assessed using the palpation technique.ResultsNearly 46% of patients were found to reuse needles, while 42.5% failed to alternate the injection site and 23% revealed unexplained hypoglycemic events. A substantial percentage of patients (approximately 47%) showed grade 1 LH, followed by 33.7% with grade 2 and 19.3% with grade 3 LH. A higher frequency of LH was observed in the thigh region (n = 28, 33.7%) than in the arm, which was second highest (n = 23, 27.7%). Patients aged ≥16 years showed a higher frequency of LH than those aged <16 years. Patients with uncontrolled diabetes mellitus had a greater likelihood of having LH (59.5%) than those with controlled diabetes (20.8%). Significant differences in LH were observed based on needle length, needle reuse, and rotation of the injection sites. On performing regression analysis, the independent risk factors for LH were found to be as follows: higher BMI, higher HbA1c, a higher number of injection sites, a higher rate of needle reuse and failed to alternate the injection site.ConclusionAs the frequency of LH was found to be high in Saudi patients with T1DM, it is essential to educate patients on the risk factors for LH and on diabetic control.

Screening of Lipohypertrophy (LH) in type 1 and type 2 diabetes patients and factors influencing this condition

“…Though difference was not significant (p=0.273). The prevalence in this study is similar to a study by Al Hayek et al 16 However other studies found a prevalence of LH was high in type 2 diabetes patients. 7,8 Prevalence of LH was more in females compared to males.…”

Prevalence of lipohypertrophy in insulin‐treated diabetes patients: A systematic review and meta‐analysis

“…Interrater reliability of reviewers regarding study relevancy was high (Kappa = 0.86). Nine studies took place in Asia, 14 in Europe, and one each in North America, Africa and a mix of different countries. The median of the mean ages was 46 years (range 6.5–63.8 years), and the median percentage of males represented in the sample was 50% (range 27.3–59.1%).…”

“…In addition, the median number of participants per study was 228 (range 54–4352), the median of mean disease duration was 10.0 years (range 2.8–17.0 years) and the median of mean insulin treatment duration was 9.3 years (range 3.0–15.0 years). When evaluated by the modified Newcastle–Ottawa quality assessment criteria, out of 5 possible points, one study received 5 points, seven studies received 4 points, 14 received 3 points, three received 2 points and one received 1 point.…”

Double diabetes in Saudi Arabia: A new entity or an underestimated condition

“…This higher BMI percentage may possibly be a result of the dramatic rise in the standard of living and the “Westernized” lifestyle habits adopted in Saudi Arabia. Unhealthy and unwise dietary choices coupled with reduced physical activity have produced this situation[12,18-20]. The growing “obesogenic” state that induced insulin resistance could account for the development of islet cell autoimmunity via different mechanisms.…”