Prevention of Insulin Induced Lipohypertrophy in Diabetic Patients: New Attempt

Presentation Number: MON 638
Date of Presentation: April 3rd, 2017

Natalya Volkova*1, Ilya Davidenko2, Maria Porksheyan3, Igor Reshetnikov4, Irina Dzherieva5, Julia Rudakova2, Aida Gulmagomedova5, Alexander Zibarev6 and Alexey Harlamov6
1The Rostov State Medical University, Rostov-on-Don, Russia, 2Rostov State Medical University, Rostov-on-Don, Russia, 3Rostov State Medical University, Rostov-on-don, 4Rostov State Medial University, Rostov on Don, Russia, 5Rostov State Medical University, Rostov on Don, Russia, 6Rostov State Medical University

Abstract

Lipohypertrophy (LH) is a chronic complication of diabetes mellitus that caused by frequent subcutaneous injections of insulin. It may develop in any age, any injection site, and it could be any size (1). Nowadays, LH were modified due to good quality modern insulin and expansion their concentration. As a result, new method, as ultrasonography of subcutaneous fat, of LH diagnostics were appeared. On the basis of results of ultrasonography of subcutaneous fat prevalence of LH in diabetic patients is still high (2). The aim of this study has been to develop prevention of insulin induced LH in diabetic patients. This study was done on 140 diabetic patients (89 females and 51 males) who had been under the treatment with insulin a mean 8 years. Ultrasonography of subcutaneous fat were used in assessing LH in these diabetics. On first stage all patients were divided into two groups. First group included 117 patients with LH, second – 23 diabetics without pathologic areas of subcutaneous fat. Further, all known, as well as additional LH risk factors were statistically processed using Spearman`s, Kendall tau, Gamma rank correlation coefficients. Results were statistically significant when p<0,05. Also measure area under curve (AUC) was determined. On second stage 65 patients from first group were divided into two subgroups. First subgroup included 50 patients with LH and corrected risk factors, second (control) – 15 diabetics with LH and uncorrected risk factors. Ultrasonography of subcutaneous fat were used in assessing new LH in these subgroups after 3 and 6 month. As a result, All risk factors were analyzed using Spearman`s, Kendall tau, Gamma rank correlation coefficients on first stage. Statistically insignificant parameters were eliminated (p>0,05). 10 factors from 23 were remained after first stage. Further, 10 parameters were subjected to ROC-analysis. Measure AUC was determined. All risk factors had high predictive value (AUC > 0,5). Ultrasonography of subcutaneous fat were used in assessing new LH On next stage. As a result, in first subgroup only 2 patients (4%) had new LH, while in second – 9 diabetics (60%) had new pathologic areas of subcutaneous fat after 3 month. And in first subgroup only 6 patients (12%) had new pathologic areas of subcutaneous fat, while in second – 12 diabetics (80%) had new pathologic areas of subcutaneous fat after 6 month. Nowadays, LH remains severe insulinotherapy complication. Primary prevention is necessary for diabetic patients with pathologic areas of subcutaneous fat. There were stated that only 10 risk factors strongly influence on lipohypertrophy progress. Correction of these risk factors doesn`t lead to development of new subcutaneous fat pathological changes and could be used to prevent lipohypertrophy in diabetic patients in clinical daily practice.

 

Nothing to Disclose: NV, ID, MP, IR, ID, JR, AG, AZ, AH