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Ultrasound characterization of insulin induced lipohypertrophy in type 1 diabetes mellitus.

Abstract：

OBJECTIVE:Subcutaneous insulin absorption is one of the key factors affecting glycemic control in patients with diabetes mellitus under insulin therapy. Insulin-induced subcutaneous lipohypertrophy has been reported to impair insulin regular absorption and hence glycemic control. So far, lipohypertrophy diagnosis has only been clinical. This study aims at evaluating the possible role of ultrasound scan in the assessment of subcutaneous lipohypertrophy in patients affected by type 1 diabetes mellitus. METHODS:A pilot observational retrospective study was performed in 20 patients affected by type 1 diabetes mellitus. In these patients the areas with clinical evidence of lipohypertrophy dependent on the insulin injections were characterized by the presence of tissues that at the ultrasound scan resulted similar to fibrotic tissues (hyperechogenic) or to an interstitial edema or to fat tissues (hypoechogenic). It was utilized a multi frequency linear probe (6-18 MHz). The patients were advised to avoid insulin injections on the areas with lipohypertrophy scanned by the ultrasound and the HbA1c changes were evaluated 3 months later. RESULTS:The lipohypertrophic areas presented at least three different aspects upon ultrasound assessment: the iso-hyperechogenic one, with a predominant fibrotic component; the isoechogenic one, with "large tangles" fibrotic elements and the iso-hypoechogenic aspect with no fibrotic elements. When patients were advised to avoid insulin injections on areas with lipohypertrophy defined by ultrasound scan, 3 months after the first evaluation HbA1c had significantly improved (basal HbA1c 7.87 ± 0.56 versus 7.67 ± 0.52 3 months later, p = 0.029). No significant improvements of the HbA1c were found in the control matched group in which lipohypertrophy was only clinically valued through inspection and palpation. CONCLUSIONS:Ultrasound scan can help identify and characterize the lipohypertrophic areas and this might be useful to improve glycemic control.

journal_name

J Endocrinol Invest

journal_title

Journal of endocrinological investigation

authors

Bertuzzi F,Meneghini E,Bruschi E,Luzi L,Nichelatti M,Epis O

doi

10.1007/s40618-017-0675-1

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

1107-1113

issue

eissn

0391-4097

issn

1720-8386

pii

10.1007/s40618-017-0675-1

journal_volume

pub_type

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Ultrasound characterization of insulin induced lipohypertrophy in type 1 diabetes mellitus.