Impact of insulin injection induced lipohypertrophy on multidimensional glucose variability in patients with type 1 diabetes mellitus / 中华内分泌代谢杂志

Objective:This study aimed to investigate the effect of lipohypertrophy induced by insulin injection on blood glucose fluctuation in patients with type 1 diabetes mellitus.Methods:A total of 80 patients with type 1 diabetes mellitus were recruited between June 2021 and December 2021 from the First Affiliated Hospital of Nanjing Medical University. And these patients all received insulin injection more than six months. Lipohypertrophy was assessed by ultrasound scanning, and blood glucose fluctuation was evaluated using the flash glucose monitoring system(FGM). Univariate analysis and multivariate linear regression were used to analyze the relationship of lipohypertrophy and and core indicators of blood glucose fluctuation.Results:Compared with patients without lipohypertrophy, patients with lipohypertrophy had higher mean amplitude of glycemic excursions(MAGE), coefficient of variation(CV), mean of daily differences(MODD), standard deviation(SD) of blood glucose, time above range(TAR), and high blood glucose index(HBGI; all P<0.05), while time in range(TIR) of glucose markedly become lower( P<0.01). Moreover, multivariate linear regression analysis showed that lipohypertrophy detected by ultrasound was an independent influencing factor of TIR( β=-9.423, P=0.032), MAGE( β=1.114, P=0.039), CV( β=4.304, P=0.041), MODD( β=0.717, P=0.046) after adjusting for age at diagnosis, duration of insulin injection, fasting C-peptide, and daily dose of insulin per unit weight. Conclusion:Lipohypertrophy increases glycemic variability and imposes negative impact on glycemic control rate in patients type 1 diabetes mellitus.

Efecto de una intervención educativa sobre la técnica de autoadministración de insulina para prevenir lipohipertrofias / Effect of an educational intervention on insulin self-administration technique to prevent lipohypertrophy / Efeito de uma intervenção educativa sobre a técnica de auto-aplicação de insulina para prevenção de lipohipertrofia

Introducción: Ante las complicaciones que presentan los pacientes diabéticos surge la necesidad de desarrollar estrategias educativas de autocuidado que mejoren la calidad de vida. Objetivo:determinar el efecto de una intervención educativa sobre la técnica correcta de la autoadministración de insulina en personas insulinorrequirientes para la prevención de lipohipertrofias en el municipio de San Gil. Metodología:estudio epidemiológico cuasiexperimental; se utilizó un instrumento de medición con prueba antes y después, con una muestra conformada por 86 personas diabéticas insulinorrequirientes con diabetes mellitus tipo 1 y 2.Resultados:en el pretest, el nivel de conocimiento sobre la administración de insulina presenta nivel bajo en el 19,5 %, nivel medio en el 5,2 % y nivel alto en el 75,3 %; en el postest el 100 % presentó nivel de conocimiento alto.Conclusión: La intervención educativa sobre la técnica correcta de la autoadministración de insulina en personas insulinorrequirientes para la prevención de lipohipertrofias tuvo un efecto positivo ya que los pacientes lograron alcanzar un nivel alto en sus conocimientos que mejoraron la técnica de administración de insulina para un tratamiento eficaz.

Introduction: Given the complications experienced by diabetic patients, there is a need to develop educational strategies for self-care to improve their quality of life.Objective: To determine the effect of an educational intervention on the correct technique for self-administration of insulin in insulin-requiring diabetic patients to prevent lipohypertrophy in the municipality of San Gil.Methods: This was a quasi-experimental epidemiological study; a measurement instrument with pre- and posttest evaluation was used in a sample of 86 insulin-requiring diabetic patients with type 1 and 2 diabetes mellitus.Results: In the pretest, the level of knowledge of insulin administration was low in 19.5% of the participants, middle in 5.2%, and high in 75.3%; in the posttest, 100% showed a high level of knowledge.Conclusion: The educational intervention on the correct technique of insulin self-administration in insulin-requiring diabetic patients to prevent lipohypertrophy had a positive effect as patients could reach a high level of knowledge and improved the insulin administration technique for effective treatment

ntrodução: Diante das complicações apresentadas pelos pacientes diabéticos, surge a necessidade de desenvolver estratégias educativas de autocuidado que melhorem a qualidade de vida.Objetivo: determinar o efeito de uma intervenção educativa sobre a técnica correta de auto-aplicação de insulina em pessoas que necessitam de insulina para prevenção de lipohipertrofia no município de San Gil.Metodologia: estudo epidemiológico quase experimental. Utilizou-se um instrumento de medida com teste antes e depois, com amostra composta por 86 diabéticos insulino-requerentes com diabetes mellitus tipo 1 e 2.Resultados: no pré-teste, o nível de conhecimento sobre administração de insulina apresenta baixo nível em 19 ,5%, nível médio em 5,2% e nível alto em 75,3%; no pós-teste, 100% apresentaram alto nível de conhecimento.Conclusão: A intervenção educativa sobre a técnica correta de autoadministração de insulina em pessoas insulino-requerentes para prevenção de lipohipertrofia teve um efeito positivo, pois os pacientes conseguiram atingir um alto nível de conhecimento que melhorou a técnica de administração de insulina para um tratamento efetivo

Impact of the depth of lipohypertrophy assessed by ultrasound on glycemic control in diabetic patients / 中华内分泌代谢杂志

To evaluate the impact of the depth of lipohypertrophy on glycemic control in diabetic patients, 498 diabetic patients were recruited from July 2017 to July 2020 in the First Affiliated Hospital of Nanjing Medical University. Their demographic and clinical data were collected. Lipohypertrophy was assessed with ultrasound. 85.1%(424/498) of patients had lipohypertrophy. The average depth of lipohypertrophy was(5.62±2.49) mm. Compared with HbA 1C≤7%, patients with HbA 1C>7% had significantly higher proportion of lipohypertrophy with depth >5 mm(69.7% vs 81.3%, P<0.05). After adjusting potential confounders, the level of HbA 1C in patients with the depth of lipohypertrophy>5 mm was still significantly higher than those with the depth of lipohypertrophy≤5 mm( OR=1.716, 95% CI 1.104-2.668, P<0.05). The depth of lipohypertrophy may be an independent risk factor for suboptimal HbA 1C. However, prospective studies are still needed to confirm.

Development of a Checklist for the Detection of Lipohypertrophy at Insulin Injection Sites / 임상당뇨병

Lipohypertrophy refers to the phenomenon of subcutaneous fatty tissue becoming either softer or firmer than normal so that it becomes thickened. The presence of lipohypertrophy is associated with not rotating injection sites correctly, injecting into the same sites repeatedly, using smaller injection zones, and reusing needles. Injecting into lipohypertrophy sites can cause unexplained hypoglycemia because insulin absorption is delayed or erratic, thus potentially worsening glucose levels and even diabetes management. Therefore, developing a lipohypertrophy checklist for patients who inject insulin is necessary to detect lipohypertrophy as soon as possible in order to avoid repeatedly injecting into lipohypertrophy sites. A lipohypertrophy checklist will help patients maintain stable glucose levels by minimizing the risk of glycemic variability.

Discordance beteeen body mass index and anthropmetric measurements among hiv-11-infected patients on antiretroviral therapy and with lipoatrophy/lipohypertrophy syndrome / Discordância entre o índice de massa corporal e outras medidas antropométricas em pacientes infectados pelo HIV com a síndrome de lipoatrofia/lipohipertrofia em uso de medicação antirretroviral

Introduction: Highly Active Antiretroviral Therapy (HAART) has improved and extended the lives of thousands of people living with HIV/AIDS around the world. However, this treatment can lead to the development of adverse reactions such as lipoatrophy/lipohypertrophy syndrome (LLS) and its associated risks. Objective: This study was designed to assess the prevalence of self-reported lipodystrophy and nutritional status by anthropometric measurements in patients with HIV/AIDS. Methods: An observational study of 227 adult patients in the Secondary Immunodeficiencies Outpatient Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (3002 ADEE-HCFMUSP). The sample was divided into three groups; Group 1 = 92 patients on HAART and with self-reported lipodystrophy, Group 2 = 70 patients on HAART without self-reported lipodystrophy and Group 3 = 65 patients not taking HAART. The nutritional status of individuals in the study sample was determined by body mass index (BMI) and percentage of body fat (% BF). The cardiovascular risk and diseases associated with abdominal obesity were determined by waist/hip ratio (WHR) and waist circumference (WC). Results: The prevalence of self-reported lipoatrophy/lipohypertrophy syndrome was 33% among women and 59% among men. Anthropometry showed depletion of fat mass in the evaluation of the triceps (TSF) in the treatment groups with HAART and was statistically independent of gender; for men p = 0.001, and for women p = 0.007. Similar results were found in the measurement of skin folds of the upper and lower body (p = 0.001 and p = 0.003 respectively). In assessing the nutritional status of groups by BMI and % BF, excess weight and body fat were more prevalent among women compared to men (p = 0.726). The WHR and WC revealed risks for cardiovascular and other diseases associated with abdominal obesity for women on HAART and with self-reported LLS (p = 0.005) and (p = 0.011). ...

Objetivos: A terapia antirretroviral altamente ativa (HAART) tem melhorado e aumentado a vida de milhares de pessoas que vivem com a infecção pelo HIV/AIDS em todo o mundo. No entanto, este tratamento pode levar ao desenvolvimento da síndrome da lipodistrofia (LDS). Este estudo foi desenvolvido para avaliar a prevalência de auto-relato de LDS, perfil nutricional e medidas antropométricas de pacientes com HIV/AIDS. Métodos: Estudo observacional de 227 pacientes adultos, divididos em: Grupo 1: 92 pacientes em HAART e com LDS; Grupo 2: 70 pacientes em tratamento com HAART e sem LDS e Grupo 3: 65 pacientes que não tomam HAART. O estado nutricional foi avaliado pelo índice de massa corporal (IMC) e o percentual de gordura corporal (%GC) por meio de medidas antropométricas. Resultados: A prevalência de auto-relato de LDS foi de 44% entre as mulheres e 39% entre os homens. DC do tríceps (PCT) apresentou-se mais elevada no grupo HAART e LDS (homens p < 0,001; mulheres p < 0,007) em comparação com aqueles sem HAART, respectivamente. IMC revelou excesso de peso para a maioria dos indivíduos. Conclusões: As medidas antropométricas foram úteis para confirmar a prevalência de auto-relato da síndrome da lipodistrofia. A avaliação das dobras dos braços e pernas revelou-se um bom método para avaliação antropométrica de lipoatrofia de membro, independentemente do sexo. Estes resultados permitiram o estabelecimento de estratégias para o diagnóstico precoce da LDS na prática clínica, em pessoas vivendo com HIV / AIDS. .