26 Insulin-induced lipodystrophy and predisposing factors in children and adolescents with type 1 diabetes mellitus (T1DM) in a tertiary care Egyptian center

Background Lipodystrophy (LH) is one of the most common complications of subcutaneous insulin injection. Many factors are incriminated in the evolution of LH in children with diabetes type 1 (T1DM). LH may affect insulin absorption in skin areas involved, resulting in negative impact on blood glucose levels and glycemic variability. Aim of Study the aim to study Insulin-induced lipodystrophy and predisposing factors in children and adolescents with type 1 diabetes mellitus (T1DM) in a tertiary care Egyptian center Methods We calculated evaluated the prevalence of LH in relation to possible clinical factors associated with the development of LH in a cohort of children (n =115) with T1DM using insulin pens or syringes and we studied possible predisposing factorsincluding their age, duration of T1DM, injection technique, insulin dose/kg, degree of pain perception, and HbA1c level. Results In our cross-sectional study, 84% of patients were using pens for insulin injection and 52.2% of them were rotating the site of injec-tion on daily basis. 27% did not experience pain during injection while 6% had the worst hurt. 49.5% had clinically detectable LH. Those with LH had higher HbA1c level and more unexplained hypoglycemic events compared to those without LH (P: 0.058). The hypertrophied site was related to the preferred site of injection which was the arms in 71.9% of the cases. Children who had LH were older with longer duration of T1DM, rotating sites of injection less frequently and were more frequently reusing needles compared to children with-out LH (P: < 0.05). Conclusion(s) Improper insulin injection technique, older age, and longer duration of T1DM were associated with LH. Proper education of patients and their parents must include correct injection tech- niques, rotating injection sites, and minimal reuse of needles.