Abstract
Introduction: As well as its negative effect on the subcutaneous tissues, lipohypertrophy has negative effects on clinical data. The purpose of this study was to examine the frequency of lipohypertrophy, risk factors and perceived barriers preventing rotation in individuals with type 2 diabetes. Methods: This descriptive cross-sectional study was conducted at Diabetes Education Center and Endocrine and Metabolism Clinic of a university hospital and Diabetes Education and Monitoring Center in a private hospital in Turkey between June 2016- April 2017. The inclusion criteria were as follows; undergoing at least one year of insulin therapy, injecting insulin pens or syringes themselves, being over 18 years of age, making regular injection of insulin and being a patient with type 2 diabetes. Introductory information form was used to collect the data. The data were analyzed using descriptive statistics and chi-square analysis with SPSS version 16.0. Results: Factors influencing lipohypertrophy development were determined as follows; healthcare personnel who provide insulin education, duration of diabetes, the number of injection administered daily, needle length, the number of injection sites, insulin types, injection site rotation and intra-site rotation and needle exchange frequency. In addition, the prevalence of lipohypertrophy was found to be higher in patients with hypoglycemia, unexplained hypoglycemia, and those with high BMI and A1C. Conclusion: It is recommended that diabetes education should be provided by the diabetes specialist nurses who have diabetes-specific certifications and / or education and who can provide full-time education. Randomized controlled interventional studies investigating how to prevent the lipohypertrophy development are also needed.
Highlights
As well as its negative effect on the subcutaneous tissues, lipohypertrophy has negative effects on clinical data
Socio-demographic characteristics of the individuals with diabetes constituting the sample group revealed that 63.5% of the patients were female and 36.5% were male; 37.6% were at the age of 60-69 years, 34.4% were primary school graduates, 48.1% were overweight, and 62.8% previously received insulin education from nurses (Table 1)
Considering the characteristics associated with diabetes, the duration of diabetes was ≥ 10 years in % 65.6 of the patients with diabetes, 57.8% received diabetes treatment between 3-9 years, 32.6% had two injections daily, 34.6% used 5 mm-needles, 41.5% used the three sites for insulin injection, 59.6 received daily dose of insulin less than 50% units, 41.1% administered pre-mixed insulin’s and 63.5% had no systematic rotation
Summary
Factors influencing the development of lipodystrophy were reported as follows; the duration of insulin therapy, daily insulin dose, the number of injections per day, gender, body mass index (BMI), injection site, not rotating the injection site, using a pen or syringe, needle length and the frequency of needle exchange, insulin type[5] and poor glycemic control.[1,2,3,6]. As well as its negative effect on the subcutaneous tissues, lipohypertrophy has negative effects on clinical data.[2,7,8,9] The pain sensation is reduced in the injection site where lipohypertrophy develops, and individuals with diabetes may be willing to inject at this site continuously because of not having a sense of pain. While the whole insulin dose injected at healthy/normal subcutaneous tissue is absorbed, hypoglycemia risk can be experienced in the lipohypertrophic region due to impaired absorption of insulin.[2,7,8,9]
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