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Ultrasound characterization of insulin induced lipohypertrophy in type 1 diabetes mellitus

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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.

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Abbreviations

CSII:

Continuous subcutaneous insulin infusion

MDI:

Multiple daily injections

HbA1c:

Glycated hemoglobin

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Acknowledgements

We thank dott.ssa Giusy Coppola for the English revision of the text.

Author Contribution

All the authors gave a substantial contribution to conception, design and critically revision of the final version. In particular: E.M., E.B participated in the research design and the performance of the research; M.N. participated in data analysis, L.L. participated in the research design and writing of the manuscript, O.E. participated in the research design and performance of the research. F.B. participated in performance of the research, research design and writing of the manuscript.

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Authors and Affiliations

  1. Diabetes Unit, SSD Diabetologia, Niguarda Ca’ Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy

    F. Bertuzzi

  2. SS Diabetologia, Bassini Hospital, Cinisello Balsamo, Milan, Italy

    E. Meneghini

  3. SC Reumatologia, Niguarda Ca’ Granda Hospital, Milan, Italy

    E. Bruschi & O. Epis

  4. Metabolism Research Center and Endocrinology and Metabolism, IRCCS Policlinico San Donato Milanese, Milan, Italy

    L. Luzi

  5. Department of Biomedical and Health Sciences, University of Milan, Milan, Italy

    L. Luzi

  6. Service of Biostatistics Niguarda Cancer Center, Niguarda Ca’ Granda Hospital, Milan, Italy

    M. Nichelatti

Authors
  1. F. Bertuzzi
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  2. E. Meneghini
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  3. E. Bruschi
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  4. L. Luzi
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  6. O. Epis
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Correspondence to F. Bertuzzi.

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The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. The local responsible Ethics Committee has given specific approval. Informed consent was obtained from all patients for being included in the study when it was required. The ClinicalTrials.gov Identifier number is NCT02278926.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Bertuzzi, F., Meneghini, E., Bruschi, E. et al. Ultrasound characterization of insulin induced lipohypertrophy in type 1 diabetes mellitus. J Endocrinol Invest 40, 1107–1113 (2017). https://doi.org/10.1007/s40618-017-0675-1

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  • DOI: https://doi.org/10.1007/s40618-017-0675-1

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