Abstract
Lipohypertrophy (LHT) has been suggested as an outcome of the adipogenic effects of insulin injection-related tissue trauma. It commonly occurs in the clinical setting, but the current understanding of LHT by the medical staff and diabetes patients remains insufficient; moreover, it has not garnered attention as a research topic. To investigate the ultrasound characterization of LHT, to identify the factors associated with LHT development by assessing the prevalence of LHT and compare the accuracy of clinical palpation with that of ultrasonography in LHT detection, and to further evaluate the possible impact of LHT on patients' blood glucose fluctuations. A cross-sectional study was conducted in 120 patients with type 2 diabetes. Patients' general information were obtained using a questionnaire, and the patients were evaluated for LHT by ultrasonography and clinical palpation of the abdomen. The patients were instructed to inject equal amounts of insulin in tissues with LHT and in normal adipose tissues (NATs) in two non-consecutive d in a selected week; the possible effect of LHT on patients' blood glucose fluctuations was assessed using a continuous glucose monitoring system. LHT has characteristic ultrasonic signs. We found a high rate of missed LHT detection on clinical palpation compared with that on ultrasonography (P < 0.05). The duration of insulin treatment, rotation of injection sites, frequency of needle reuse, and number of insulin injections per day were the primary factors influencing the development of LHT (P < 0.05). Compared with NATs, LHT tissues showed extremely elevated amplitude of glycemic excursion, mean blood glucose levels, standard deviation of blood glucose levels and postprandial glucose excursion, and large fluctuations in blood glucose levels (P < 0.05). Ultrasonography can more accurately detect LHT than can clinical palpation. LHT development is associated with several factors and can lead to significant fluctuations in blood glucose levels; thus, sufficient attention should be paid to investigating the underlying mechanism of LHT.
Highlights
Insulin, a commonly used hypoglycemic drug, is itself a growth factor with growth-promoting effects, inducing protein and fat differentiation and proliferation
We found a high rate of missed clinical palpation of LHT compared with ultrasonography (P < 0.05)
The duration of insulin treatment, whether to rotate the injection site, frequency of needle use, and number of insulin injections per day were the main factors influencing the development of LHT (P < 0.05)
Summary
A commonly used hypoglycemic drug, is itself a growth factor with growth-promoting effects, inducing protein and fat differentiation and proliferation. LHT is mostly evaluated by palpation and visualization in clinical treatment, which is a simple, convenient method that is easy to promote. This method lacks specificity and can only be detected when the lesion is obvious. Lipohypertrophy (LHT) has been suggested as an outcome of adipogenic effects of insulin injectionrelated tissue trauma. It is common clinically, but the current understanding of LHT by medical staff and diabetic patients is still insufficient, and it has not attracted attention as a research topic
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