Factors Hindering Correct Identification of Unapparent Lipohypertrophy

i. Introduction:A correct injection technique is essential to prevent lipohypertrophy (LH) in people with diabetes mellitus (DM) and related glucose oscillations. However, features associated with missed LH identification are mostly unknown. ii. Aim of the study: to find out how lesion features influence LH identification and to assess patients’ awareness of the problem. iii. Materials and Method: 60 patients with LH lesions (36 F, 24 M, 56 ± 13 years of age) treated with four insulin shots per day were enrolled. All were blindly examined by four non-trained (NT) and four well trained (WT) health professionals (HPs) and filled in a questionnaire concerning their own experience. iv. Results:WT HPs were better at identifying LH lesions (OR 10.52 [4.34-25.50], p<0.001) but WT HPs were mostly wrong in the case of flat lesions located on the arms. By contrast, NT HPs failed identification of all possible lesion kinds. Patients’ answers to the questionnaire indicated a serious education gap concerning both insulin storage and injection technique, mostly dependent on inadequate follow-up by the care team. v. Conclusion:To avoid most common mistakes including repeated shots into LH lesions and inappropriate insulin storage, continuous surveillance and exchange of information between care team and patients are necessary. To train patients on how to identify LH lesions by self-palpation and accurate skin inspection is crucial and can be easily done now according to structured education. The latter can improve clinical outcomes with little effort and can be further improved only by systematic and extensive utilization.