Factors related to lipohypertrophy in insulin‐treated diabetic patients: role of educational intervention

The objective of this study was to relate the presence of lipohypertrophy in insulintreated diabetic patients with accessible clinical variables, with the aim of identifying risk factors associated with the development of lipohypertrophy which may be prevented through educational intervention. One hundred and fifty patients with insulin‐treated diabetes of at least one year's duration were recruited consecutively. Clinical and metabolical data and type of insulin therapy were evaluated. Injection sites and systematised rotation of injection site were also assessed. Female sex, Type I diabetes, higher body mass index (BMI) and missing rotation of injection sites were all identified as independent risk factors for the presence of lipohypertrophy. The need to change injection sites regularly was acknowledged by most of our patients (78.7%), however only 22.7% followed an organised rotation system. The latter group of patients had the lowest frequency of lipohypertrophy and the least unstable glycaemic profile. Therefore an essential issue in diabetes care for all patients on insulin therapy should be: (i) to establish with the patient an organised rotation system for insulin injections; (ii) to examine injection sites regularly; (iii) to train patients to recognize lipohypertrophy; and (iv) to make patients aware of the metabolic implications of missing rotation.