Prevalence of Lipohypertrophy and Associated Risk Factors in Insulin-Treated Patients With Type 2 Diabetes Mellitus

Abstract

Background:Secondary failure of oral hypoglycemic agents is common in patients with type 2 diabetes mellitus (T2DM); thus, patients often need insulin therapy. The most common complication of insulin treatment is lipohypertrophy (LH).Objectives:This study was conducted to estimate the prevalence of LH among insulin-treated patients with Patients with T2DM, to identify the risk factors for the development of LH, and to examine the association between LH and glycemic control.Patients and Methods:A total of 1090 patients with T2DM aged 20 to 89 years, who attended the diabetes clinics at the National Center for Diabetes, Endocrinology, and Genetics (NCDEG, Amman, Jordan) between October 2011 and January 2012, were enrolled. The presence of LH was examined by inspection and palpation of insulin injection sites at the time of the visit as relevant clinical and laboratory data were obtained. The LH was defined as a local tumor-like swelling of subcutaneous fatty tissue at the site of repeated insulin injections.Results:The overall prevalence of LH was 37.3% (27.4% grade 1, 9.7% grade 2, and 0.2% grade 3). The LH was significantly associated with the duration of diabetes, needle length, duration of insulin therapy, lack of systematic rotation of insulin injection sites, and poor glycemic control.Conclusions:The LH is a common problem in insulin-treated Jordanian patients with T2DM. More efforts are needed to educate patients and health workers on simple interventions such as using shorter needles and frequent rotation of the insulin injection sites to avoid LH and improve glycemic control.

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%).…”

Basal insulin peglispro: Overview of a novel long‐acting insulin with reduced peripheral effect resulting in a hepato‐preferential action

“…Although reporting of lipohypertrophy was more common with BIL than glargine, these reporting rates are consistent with prospective studies evaluating the incidence and prevalence of lipohypertrophy in insulin‐treated patients. In such studies, lipohypertrophy has been reported in 29%‐76% of patients with T1D and in 4%‐56% of patients with T2D . Increased rates of lipohypertrophy may reflect slow absorption of BIL from injection sites via the lymphatic system, and a trophic effect on adipocytes resulting from a longer exposure of subcutaneous tissue to BIL.…”

“…In such studies, lipohypertrophy has been reported in 29%-76% of patients with T1D [51][52][53][54] and in 4%-56% of patients with T2D. 51,54,55 Increased rates of lipohypertrophy may reflect slow absorption of BIL from injection sites via the lymphatic system, 15…”

Construção, validação e avaliação de diferentes métodos educativos em diabetes mellitus para aplicação de insulina: simulador de paciente e baixo custo, vídeo e cartilha

“…Em relação à lipohipertrofia, nesse estudo, observou-se que 17 (21,3%) pacientes referiram apresentar essa complicação, todavia, por trata-se de um dado referido e não da avaliação por meio de exame físico ou ultrassom, pode ser que este número esteja subestimado. Para avaliar lipohipertrofia, recomenda-se utilizar a inspeção e palpação (AJLOUNI et al, 2015). Destaca-se que investimentos na técnica de educação para aplicação de insulina podem reduzir a prevalência de lipohipertrofia (JI et al, 2017).…”

“…No que diz respeito aos fatores de risco modificáveis para desenvolvimento o diabetes mellitus tipo 2, a obesidade, o tabagismo e o sedentarismo têm sido aspectos amplamente estudados (MASMIQUEL et al, 2016;ŚLIWIŃSKA-MOSSOŃ;MILNEROWICZ, 2017;ZHAO, 2011 (AJLOUNI, et al, 2015;FRID et al, 2016). (NETO et al,2015).…”