Incidence of lipohypertrophy of patients with diabetes: a meta-analysis_West China Medical Journal

Authors：

LI Gui ¹ ,  LI Wei ² , LI Jun ³ , SUN Wenxiu ¹ , YU Chongyan ¹ , CAO Liyun ¹

1. Department of Nephrology, Peking University First Hospital, Beijing 100034, P. R. China;
2. General Practice Center, Peking University First Hospital, Beijing 100034, P. R. China;
3. Department of Endocrinology, Peking University First Hospital, Beijing 100034, P. R. China;

Corresponding author：

LI Wei, Email: harebellw@163.com

Keywords：

Diabetes; Lipohypertrophy; Meta-analysis

DOI：

10.7507/1002-0179.202003177

Video：

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Objective To explore the incidence of lipohypertrophy in patients with diabetes by meta-analysis, and provide a reference for preventing and reducing its occurrence. Methods A computer search was performed on PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wangfang Data and Chongqing VIP databases, supplemented by literature retrospective method and manual search. Relevant documents related to lipohypertrophy in diabetic patients were searched until September 2021. After conducting independent literature screening, data extraction and quality evaluation, the researchers used RevMan 5.4.1 and R 3.3.1 softwares for meta-analysis. Results Ten articles were included, including 0 in Chinese and 10 in English, and 20277 patients in total. The incidence of lipohypertrophy in patients with diabetes was 53% [95% confidence interval (44%, 62%)]. The heterogeneity among studies was statistically significant (I²=99%, P<0.00001). Meta-regression analysis of single covariates and multiple covariates found that publication year, research scope, research area, sample source, research center, and sample size could explaine 51.6% of the heterogeneity. Conclusion The incidence of lipohypertrophy in patients with diabetes is high, and effective intervention measures are urgently needed to prevent, diagnose and treat the problem of lipohypertrophy in patients with diabetes.

Citation： LI Gui, LI Wei, LI Jun, SUN Wenxiu, YU Chongyan, CAO Liyun. Incidence of lipohypertrophy of patients with diabetes: a meta-analysis. West China Medical Journal, 2021, 36(11): 1578-1584. doi: 10.7507/1002-0179.202003177 Copy

1.	The International Diabetes Federation (IDF). IDF diabetes atlas 9th edition 2019. Brussels, Belgium: 2019. (2019-11-14)[2021-10-08].https://www.diabetesatlas.org./en/resources/.
2.	中华糖尿病杂志指南与共识编写委员会. 中国糖尿病药物注射技术指南(2016 年版). 中华糖尿病杂志, 2017, 9(2): 79-105.
3.	Thow JC, Johnson AB, Marsden S, et al. Morphology of palpably abnormal injection sites and effects on absorption of isophane (NPH) insulin. Diabet Med, 1990, 7(9): 795-799.
4.	Richardson T, Kerr D. Skin-related complications of insulin therapy: epidemiology and emerging management strategies. Am J Clin Dermatol, 2003, 4(10): 661-667.
5.	Pickup JC, Yemane N, Brackenridge A, et al. Nonmetabolic complications of continuous subcutaneous insulin infusion: a patient survey. Diabetes Technol Ther, 2014, 16(3): 145-149.
6.	Rostom A, Dube C, Cranney A, et al. Celiac Disease Rockville (MD): Agency for Healthcare Research and Quality (US), (Evidence Reports/Technology Assessments, No. 104. ) Appendix D. Quality Assessment Forms. (2004-09-10)[2021-10-08].https://www.ncbi.nlm.nih.gov/books/NBK35156/.
7.	曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
8.	Aljaber AN, Sales I, Almigbal TH, et al. The prevalence of lipohypertrophy and its associated factors among Saudi patients with type 2 diabetes mellitus. J Taibah Univ Med Sci, 2020, 15(3): 224-231.
9.	Arora S, Agrawal NK, Shanthaiah DM, et al. Early detection of cutaneous complications of insulin therapy in type 1 and type 2 diabetes mellitus. Prim Care Diabetes, 2021, 15(5): 859-864.
10.	Blanco M, Hernández MT, Strauss KW, et al. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab, 2013, 39(5): 445-453.
11.	Coninck De C, Frid A, Gaspar R, et al. Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire survey. J Diabetes, 2010, 2(3): 168-179.
12.	Frid AH, Hirsch LJ, Menchior AR, et al. Worldwide injection technique questionnaire study: injecting complications and the role of the professional. Mayo Clin Proc, 2016, 91(9): 1224-1230.
13.	Gentile S, Strollo F, Satta E, et al. Insulin-related lipohypertrophy in hemodialyzed diabetic people: a multicenter observational study and a methodological approach. Diabetes Ther, 2019, 10(4): 1423-1433.
14.	Gupta SS, Gupta KS, Gathe SS, et al. Clinical Implications of lipohypertrophy among people with type 1 diabetes in India. Diabetes Technol Ther, 2018, 20(7): 483-491.
15.	Ji L, Sun Z, Li Q, et al. Lipohypertrophy in China: prevalence, risk factors, insulin consumption, and clinical impact. Diabetes Technol Ther, 2017, 19(1): 61-67.
16.	Luo D, Shi Y, Zhu M, et al. Subclinical lipohypertrophy: easily ignored complications of insulin therapy. J Diabetes Complications, 2021, 35(3): 107806.
17.	Pozzuoli GM, Laudato M, Barone M, et al. Errors in insulin treatment management and risk of lipohypertrophy. Acta Diabetol, 2018, 55(1): 67-73.
18.	Baruah MP, Kalra S, Bose S, et al. An audit of insulin usage and insulin injection practices in a large Indian cohort. Indian J Endocr Metab, 2017, 21: 443-452.
19.	Vardar B, Kizilci S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract, 2007, 77(2): 231-236.
20.	Pahuja V, Punjot P, Fernandes G, et al. Exploring the factors associated with lipohypertrophy in insulin-treated type 2 diabetes patients in a tertiary care hospital in Mumbai, India. Int J Diabetes Develop Countr, 2019, 39(3): 426-431.
21.	Gentile S, Guarino G, Corte TD, et al. Insulin-induced skin lipohypertrophy in type 2 diabetes: a multicenter regional survey in southern Italy. Diabetes Ther, 2020, 11(9): 2001-2017.
22.	Gentile S, Guarino G, Della Corte T, et al. Bruising: a neglected, though patient-relevant complication of insulin injections coming to light from a real-life nationwide survey. Diabetes Ther, 2021, 12(4): 1143-1157.
23.	Song Z, Guo X, Ji L, et al. Insulin injection technique in china compared with the rest of the world. Diabetes Ther, 2018, 9(6): 2357-2368.
24.	Hacene MNB, Saker M, Youcef A, et al. Insulin injection technique in the western region of Algeria, Tlemcen. Pan Afr Med J, 2020, 36: 327-340.
25.	李幼平, 杨克虎. 循证医学. 北京: 人民卫生出版社, 2014: 145-146.
26.	Conwell LS, Pope E, Artiles AM, et al. Dermatological complications of continuous subcutaneous insulin infusion in children and adolescents. J Pediatr, 2008, 152(5): 622-628.
27.	Gentile S, Guarino G, Giancaterini A, et al. A suitable palpation technique allows to identify skin lipohypertrophic lesions in insulin-treated people with diabetes. Springer Plus, 2016, 5: 563.

1. The International Diabetes Federation (IDF). IDF diabetes atlas 9th edition 2019. Brussels, Belgium: 2019. (2019-11-14)[2021-10-08].https://www.diabetesatlas.org./en/resources/.
2. 中华糖尿病杂志指南与共识编写委员会. 中国糖尿病药物注射技术指南(2016 年版). 中华糖尿病杂志, 2017, 9(2): 79-105.
3. Thow JC, Johnson AB, Marsden S, et al. Morphology of palpably abnormal injection sites and effects on absorption of isophane (NPH) insulin. Diabet Med, 1990, 7(9): 795-799.
4. Richardson T, Kerr D. Skin-related complications of insulin therapy: epidemiology and emerging management strategies. Am J Clin Dermatol, 2003, 4(10): 661-667.
5. Pickup JC, Yemane N, Brackenridge A, et al. Nonmetabolic complications of continuous subcutaneous insulin infusion: a patient survey. Diabetes Technol Ther, 2014, 16(3): 145-149.
6. Rostom A, Dube C, Cranney A, et al. Celiac Disease Rockville (MD): Agency for Healthcare Research and Quality (US), (Evidence Reports/Technology Assessments, No. 104. ) Appendix D. Quality Assessment Forms. (2004-09-10)[2021-10-08].https://www.ncbi.nlm.nih.gov/books/NBK35156/.
7. 曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
8. Aljaber AN, Sales I, Almigbal TH, et al. The prevalence of lipohypertrophy and its associated factors among Saudi patients with type 2 diabetes mellitus. J Taibah Univ Med Sci, 2020, 15(3): 224-231.
9. Arora S, Agrawal NK, Shanthaiah DM, et al. Early detection of cutaneous complications of insulin therapy in type 1 and type 2 diabetes mellitus. Prim Care Diabetes, 2021, 15(5): 859-864.
10. Blanco M, Hernández MT, Strauss KW, et al. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab, 2013, 39(5): 445-453.
11. Coninck De C, Frid A, Gaspar R, et al. Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire survey. J Diabetes, 2010, 2(3): 168-179.
12. Frid AH, Hirsch LJ, Menchior AR, et al. Worldwide injection technique questionnaire study: injecting complications and the role of the professional. Mayo Clin Proc, 2016, 91(9): 1224-1230.
13. Gentile S, Strollo F, Satta E, et al. Insulin-related lipohypertrophy in hemodialyzed diabetic people: a multicenter observational study and a methodological approach. Diabetes Ther, 2019, 10(4): 1423-1433.
14. Gupta SS, Gupta KS, Gathe SS, et al. Clinical Implications of lipohypertrophy among people with type 1 diabetes in India. Diabetes Technol Ther, 2018, 20(7): 483-491.
15. Ji L, Sun Z, Li Q, et al. Lipohypertrophy in China: prevalence, risk factors, insulin consumption, and clinical impact. Diabetes Technol Ther, 2017, 19(1): 61-67.
16. Luo D, Shi Y, Zhu M, et al. Subclinical lipohypertrophy: easily ignored complications of insulin therapy. J Diabetes Complications, 2021, 35(3): 107806.
17. Pozzuoli GM, Laudato M, Barone M, et al. Errors in insulin treatment management and risk of lipohypertrophy. Acta Diabetol, 2018, 55(1): 67-73.
18. Baruah MP, Kalra S, Bose S, et al. An audit of insulin usage and insulin injection practices in a large Indian cohort. Indian J Endocr Metab, 2017, 21: 443-452.
19. Vardar B, Kizilci S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract, 2007, 77(2): 231-236.
20. Pahuja V, Punjot P, Fernandes G, et al. Exploring the factors associated with lipohypertrophy in insulin-treated type 2 diabetes patients in a tertiary care hospital in Mumbai, India. Int J Diabetes Develop Countr, 2019, 39(3): 426-431.
21. Gentile S, Guarino G, Corte TD, et al. Insulin-induced skin lipohypertrophy in type 2 diabetes: a multicenter regional survey in southern Italy. Diabetes Ther, 2020, 11(9): 2001-2017.
22. Gentile S, Guarino G, Della Corte T, et al. Bruising: a neglected, though patient-relevant complication of insulin injections coming to light from a real-life nationwide survey. Diabetes Ther, 2021, 12(4): 1143-1157.
23. Song Z, Guo X, Ji L, et al. Insulin injection technique in china compared with the rest of the world. Diabetes Ther, 2018, 9(6): 2357-2368.
24. Hacene MNB, Saker M, Youcef A, et al. Insulin injection technique in the western region of Algeria, Tlemcen. Pan Afr Med J, 2020, 36: 327-340.
25. 李幼平, 杨克虎. 循证医学. 北京: 人民卫生出版社, 2014: 145-146.
26. Conwell LS, Pope E, Artiles AM, et al. Dermatological complications of continuous subcutaneous insulin infusion in children and adolescents. J Pediatr, 2008, 152(5): 622-628.
27. Gentile S, Guarino G, Giancaterini A, et al. A suitable palpation technique allows to identify skin lipohypertrophic lesions in insulin-treated people with diabetes. Springer Plus, 2016, 5: 563.

West China Medical Journal

Incidence of lipohypertrophy of patients with diabetes: a meta-analysis

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