Insulin injection technique errors can cause a high rate of skin lipohypertrophic lesions (LHs), but these lesions are often flat and barely visible, thus requiring thorough deep palpation examination and ultrasonography (US) for identification. |
Detection of LHs is crucial to prevent poor diabetes control due to unpredictable insulin-release patterns. |
The skin undergoes fundamental structural changes with aging, potentially increasing the risk for LHs. |
In this study, 718 outpatients with type 2 diabetes mellitus with LHs were assigned to one of two age class subgroups (≤ 65 years and > 65 years) in order to evaluate whether age influences LH prevalence and various factors associated with LHs. |
The older group was found to show a stronger association between LHs and poor habits, as well as with several clinical parameters, among which the most relevant were hypoglycemic events and glycemic variability. |
The results suggest the need (1) to take specific actions to prevent and control the high risk of acute cardiovascular events expected to occur in older subjects in the case of hypoglycemic events, and (2) to identify and establish better-targeted, effective educational programs specifically in patients in the older age category. |
Digital Features
Introduction
Methods
Patient characteristics, insulin injection habits and complications of diabetes | Enrolled subjects (n = 1227) | p | |
---|---|---|---|
Age ≤ 65 years | Age > 65 years | ||
Clinical characteristics | |||
Subjects, n (%) | 817 (67) | 410 (33) | 0.001 |
Male gender, n (%) | 327 (40) | 97 (23) | 0.05 |
Mean age (years) | 53 ± 13 | 73 ± 8 | 0.01 |
Body mass index (kg/m2) | 31 ± 5 | 27 ± 6 | 0.05 |
HbA1c (%) | 8.1 ± 1.2 | 8.9 ± 1.4 | 0.05 |
Since DM diagnosis (years) | 9 ± 7 | 12 ± 9 | 0.05 |
Duration of insulin treatment (years) | 8 ± 4 | 12 ± 5 | 0.01 |
Daily insulin dose requirement (IU/day) | 49 ± 15 | 43 ± 11 | 0.01 |
Subjects with HEs, n (%) | 418 (51) | 268 (65) | 0.01 |
Glycemic variability (mg/dl) | 281 ± 62 | 347 ± 69 | 0.001 |
Lipohypertrophy, n (%) | 396 (48) | 322 (79) | 0.001 |
Injection habits, n (%) | |||
Needle reuse | 495 (61) | 267 (65) | n.s. |
Failure to rotate injection sites | 397 (49) | 189 (46) | n.s. |
Ice-cold insulin injection | 411 (51) | 201 (49) | n.s. |
Suitable post-injection needle removal lag | 74 (9) | 25 (6) | n.s. |
Post-injection leakage of insulin from the injection site (drop-leaking) | 319 (39) | 193 (47) | 0.05 |
Painful injection | 131 (16) | 21 (5) | 0.01 |
Injection into LH nodules | 383 (47) | 310 (56) | 0.05 |
Diabetes complications, n (%) | |||
Cardio-/cerebro-vascular disease | 180 (22) | 144 (35) | 0.01 |
Lower limb complications | 65 (8) | 111 (27) | 0.01 |
Retinopathy | 172 (21) | 207 (49) | 0.01 |
Nephropathy/dialysis | 229 (28) | 213 (52) | 0.01 |
Sensory-motor neuropathy | 139 (17) | 164 (40) | 0.01 |
Autonomic neuropathy | 90 (11) | 131 (32) | 0.01 |
Statistical Analysis
Results
Factors associated with lipohypertrophic lesions | Subjects aged ≤ 65 years | Subjects aged > 65 years | ||
---|---|---|---|---|
95% Confidence interval | Hazard ratio | 95% Confidence interval | Hazard ratio | |
General parameters/complications | ||||
Female gender | 1.33–1.94 | 1.48 | 1.44–2.24 | 1.67 |
DM duration | 1.22–1.77 | 1.29 | 1.43–2.12 | 1.76 |
HbA1c | 0.98–2.94 | 1.81 | 1.53–2.97 | 2.11 |
Severe hypoglycemic episodes during the past 12 months | 1.52–2.97 | 2.32 | 1.78–3.21 | 2.19 |
Cardiovascular complications | 1.68–3.49 | 2.72 | 2.78–5.19 | 3.65 |
Retinopathy | 1.21–1.89 | 1.47 | 2.23–3.67 | 2.89 |
Sensory-motor neuropathy | 1.01–1.48 | 1.28 | 1.88–3.56 | 2.78 |
. End-stage renal disease/dialysis | 1.59–3.23 | 2.19 | 3.21–4.88 | 3.99 |
Associated factors | ||||
Large glycemic variability | 2.02–3.28 | 2.66 | 2.78–4.23 | 3.08 |
HEs | 1.87–3.03 | 2.11 | 1.98–3.51 | 2.87 |
Severe HEs | 2.00–3.48 | 2.49 | 2.28–3.97 | 2.95 |
Symptomatic non-severe HEs | 1.68–3.86 | 1.93 | 1.94–4.16 | 2.65 |
Injection technique | ||||
Needle reuse | 2.98–5.24 | 3.73 | 3.11–5.84 | 3.89 |
Failure to rotate injection sites | 3.21–6.18 | 4.81 | 3.44–6.88 | 5.12 |
Ice-cold insulin injection | 1.87–3.24 | 2.66 | 2.12–3.79 | 3.11 |
Post-injection drop-leaking | 1.90–2.32 | 1.58 | 1.83–3.79 | 2.08 |