DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20191105

Prevalence of insulin induced lipodystrophy in patients with diabetes mellitus in a tertiary care centre: a cross sectional study

Shravani Bezawada, Anuradha H. V., Pramila Kalra

Abstract


Background: Diabetes Mellitus is a spectrum of common metabolic disorders whose management mainly lies in treating the patients with oral hypoglycaemic drugs and insulin along with the dietary and lifestyle modifications. Lipodystrophy is the most neglected adverse drug effect caused by injecting insulin. The main objective of this study was to assess the prevalence of lipodystrophy at the insulin injection sites in patients suffering from diabetes mellitus (Type 1 and Type 2).

Methods: A cross-sectional study was conducted in the Department of Endocrinology on 250 diabetic patients taking insulin injections based on inclusion and exclusion criteria. The demographic features and anthropometric measurements were noted. Insulin injection sites were examined clinically by inspection and palpation for presence of swelling like lipodystrophy, injection marks and signs of allergy like erythema etc. Lipodystrophy was graded from 0-3 and denoted as lipohypertrophy or lipoatrophy. The results were tabulated and presented accordingly.

Results: In this study, out of 250 patients 17 (6.8%) patients presented with insulin induced lipodystrophy. Lipohypertrophy was the most common presentation and only one case presented with lipoatrophy.

Conclusions: It can be concluded from the present study that lipodystrophy which is an important adverse effect due to insulin injection needs to be monitored regularly in every patient taking insulin for better control of glucose levels.


Keywords


Adverse drug reaction, Diabetes, Insulin, Lipodystrophy, Prevalence

Full Text:

PDF

References


American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2012;35(1):64S-71S.

Kaveeshwar S. The current state of diabetes mellitus in India. Australasian Med J. 2014;7(1):45-8.

Alvin C, David D’A. Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and hypoglycemia. In: Bruton L, Chabner B, Knollman B. Goodman and Gilman's the pharmacological basis of therapeutics. 12th ed. New York: Mc Graw- Hill Company; 2014:1144-1166.

Tripathi K. Essentials of medical pharmacology. 7th ed. Jaypee; 2013:258-278.

Kansra UC, Sircar. Insulin Therapy: Practical Points. Journal, Indian Academy of Clinical Medicine. 2000;1(3):245-51.

DK M. Patient education: Diabetes mellitus type 1: Insulin treatment (Beyond the Basics); 2017. Available at: https://www.uptodate.com/contents/diabetes-mellitus-type-1-insulin-treatment-beyond-the-basics. Cited on 13 August 2017.

Goudswaard AN, Furlong NJ, Valk GD, Stolk RP, Rutten GE. Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews. 2004;4.Art. No: CD003418.

Chaudhury A, Duvoor C, Reddy DV, Kraleti S, Chada A, Ravilla R, et al. Clinical Review of Antidiabetic Drugs: Implications for Type 2 Diabetes Mellitus Management. Frontiers in Endocrinology. 2017;8(6):1-12.

James WD, Berger T. Clinical Dermatology. 10th ed. Elsevier Health Sciences; 2006:538-541.

Al Ajlouni M, Abujbara M, Batieha A, Ajlouni K. Prevalence of Lipohypertrophy and associated risk factors in Insulin-treated patients with Type 2 Diabetes Mellitus. Int J Endocrinology Metabolism. 2015;13(2):E20776. Available at: Http://Www.Ncbi.Nlm.Nih.Gov/Pmc/Articles/PMC4397947. Cited on 13 August 2017.

Kadiyala P, Walton S, Sathyapalan T. Insulin Induced Lipodystrophy. Bri J Diab Vascu Dise. 2014;14(4):131-3.

Mokta J, Mokta K, Panda P. Insulin lipodystrophy and lipohypertrophy. Ind J Endocrinol Metabol. 2013;17(4):773.

Breznik V, Kokol R, Luzar B, Miljkovic J. Insulin-Induced Localized Lipoatrophy. Department Acta Dermatovenerol APA. 2013;22:83-5.

Hauner H, Stockamp B, Haastert B. Prevalence of Lipohypertrophy In Insulin- Treated Diabetic Patients And Predisposing Factors. Exp Clin Endocrinol Diabetes. 1996;104(2):106-10.

Kashi Z, Haiheydan Z, Akha O, Akbarzadeh S. Prevalence of lipodystrophy associated with recombinant insulin. Mazandaran Uni Med Sci J. 2008;18:9.

Blanco M, Hernández M, Strauss K, Amaya M. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes and Metabolism. 2013;39(5):445-53.

Gentile S, Guarino G, Giancaterini A, Guida P, Strollo F. A suitable palpation technique allows to identify skin lipohypertrophic lesions in insulin-treated people with diabetes. Springer plus. 2016;5(1):3-4.52.

Das S. A Manual on Clinical Surgery. 12th ed.; 2016:17-33.

Frid AH, Hirsch LJ, Menchoir AR, Morel D, Strauss K. Worldwide injection technique questionnaire study: population parameters and injection practices. Mayo Clinic Proc. 2016;91(9):1212-23.

Frid AH, Hirsch LJ, Menchoir AR, Morel D, Strauss K. Worldwide injection technique questionnaire study: injecting complications and role of the professional. Mayo Clinic Proc. 2016;91(9):1224-30.

Thomas NJ, Honey KR, Abraham A, Pandey M, Kumaraswamy M, Kumar BPS. A study on insulin usage among diabetic patient in a tertiary care teaching hospital. Indo Amer J Pharmace Resea. 2013;3(10):8474-8.

Harikrishnan KV, Rajasree R, Thomas N, Reghu R. Study of prescription pattern and insulin treatment in type 2 diabetic patients. Int J Pharm Pharmace Scien. 2012;4:328-30.