Lipoatrophy in Children With Type 1 Diabetes

Abstract

The objectives were to evaluate the current prevalence of lipoatrophy at insulin injection sites in young patients with type 1 diabetes. Standardized examination of insulin injection sites in all 678 patients with type 1 diabetes treated in 2013 in our outpatient clinic were conducted. In case of lipoatrophy photo documentation and standardized interview with parents and patients were performed. We identified a total of 16 patients (43.8% male) with lipoatrophy (overall prevalence 2.4%). The current mean age (±SD) of the affected patients was 14.4 ± 3.9 years, age and diabetes duration at onset of lipoatrophy were 11.5 ± 3.8 years and 5.4 ± 3.6 years, respectively. All patients were using analogs at the onset of lipoatrophy. In all, 14 of 16 patients (87.5%) were on insulin pump compared with 52% without lipoatrophy (P = .0018). The use of steel needle and Teflon catheter was equal between the pump patients. Concomitant autoimmune diseases were present in 37.5% of the patients (thyroiditis: n = 3, thyroiditis and celiac disease: n = 2, celiac disease: n = 1) compared with 15.0% in those without lipoatrophy (P = .0128). Lipoatrophy was present in young patients treated with modern insulins and pumps; however, the prevalence was relatively low as expected with the use of modern insulins. Our data may support the hypothesis that a constant mechanical element such as a subcutaneous catheter may trigger the development of lipoatrophy, particularly in those patients with more than 1 autoimmune disease.

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies

“…Lipohypertrophy, or local fat accumulation, at the site of insulin administration, is another issue that is frequently encountered with pump therapy . Fat loss at the site of prior insulin infusion sites, lipoatrophy, is less common and has been seen more frequently in those with multiple autoimmune diseases . Both of these findings are categorized as lipodystrophy and earlier studies have shown a greater risk of these issues in those with higher insulin autoantibodies .…”

“…83 Fat loss at the site of prior insulin infusion sites, lipoatrophy, is less common and has been seen more frequently in those with multiple autoimmune diseases. 84 Both of these findings are categorized as lipodystrophy and earlier studies have shown a greater risk of these issues in those with higher insulin autoantibodies. 85 Lipodystrophy can impact how insulin is absorbed and thus lead to deterioration in glycemic control.…”

Forum for injection technique and therapy expert recommendations, India: The Indian recommendations for best practice in insulin injection technique, 2017

“…[153] It is an immunological response to insulin aggregates in the presence of high circulating titers of anti-insulin autoantibodies. LA was more prevalent in the prehuman-insulin era due to the use of animal insulin.…”

Insulin Aspart–Induced Lipoatrophy Treated Successfully With Glucocorticoid Injection

“…Though it was commonly encountered among patients taking animal insulin, with the introduction of recombinant human insulin, it has become rarer. Treatment with analogue insulin has further reduced the incidence (1). Due to incompletely understood pathogenesis, lipoatrophy remained a vexing problem to physicians.…”