Consensus Recommendations on Lipohypertrophy: Insights From an International Panel of Experts

Lipohypertrophy, characterized by subcutaneous adipose tissue accumulation at sites of insulin administration, affects 29-76% of insulin-treated people with diabetes (PwD), yet remains underrecognized. This complication significantly impacts glycemic control through unpredictable insulin absorption, necessitating up to 25% higher insulin doses and increasing care costs. An evidence-informed consensus initiative was warranted to establish recommendations for the screening, prevention, and management of lipohypertrophy. A modified Delphi methodology was employed involving 13 international experts in endocrinology, primary care, and diabetes research. A structured literature review informed five consensus rounds, leading to fifteen statements addressing epidemiology, risk factors, clinical presentation, diagnosis, prevention, management, and education/training/systems. Inadequate injection site rotation was identified as the strongest modifiable risk factor for lipohypertrophy. The panel recommends systematic injection site examination every 6 months during the first 2 years of insulin therapy, then annually, with more frequent screening for high-risk PwD. Standardized examination protocols incorporating visual inspection and systematic palpation were endorsed, with ultrasound reserved for detecting subclinical lipohypertrophy. Prevention strategies emphasize proper education, site rotation, and single-use needle practices. Implementation of consensus recommendations presented here may improve glycemic outcomes, reduce insulin requirements and cost of care, and enhance quality of life for PwD on insulin therapy.