Smith Mike, Clapham Linda, Strauss Kenneth
BD Diabetes Care, The Danby Building, Edmund Halley Road, Oxford Science Park, Oxford OX4 4DQ, UK.
Wharfedale Diabetes Centre, Wharfedale Hospital, Newall Carr Road, Otley, Leeds Teaching Hospitals, LS21 2LY Leeds, UK.
Diabetes Res Clin Pract. 2017 Apr;126:248-253. doi: 10.1016/j.diabres.2017.01.020. Epub 2017 Mar 2.
Lipohypertrophy (LH) is one of the most common complications of insulin therapy. We conducted a prospective study in 18 UK centres to assess the impact of a targeted LH intervention on a range of clinical, biological and socio-economic parameters.
Seventy-five insulin-injecting patients were recruited randomly and were followed prospectively for 3-6months, with results compared to baseline values. Interventions included the use of an intensive education program and a switch to a 4mm pen needle.
At all injection sites LH decreased significantly by the end of the study, either disappearing completely or shrinking by approximately 50% from its original diameter. Injections into LH decreased by more than 75% by the end. Most patients were not correctly rotating injection sites at the beginning but by the end most were, by a 5-fold margin. Only 1/3 of our subjects used the 4mm needle at the beginning of the study, however, virtually all did by study end. The mean HbA1c improved by more than 4mmol/L and there were significantly lower levels of unexpected hypoglycaemia and glucose variability. Total daily doses of insulin dropped by an average of 5.6 IU by study end.
We believe the impressive clinical improvements seen with training to prevent LH can be achieved by wide adoption of the interventions outlined in this study.
脂肪增生（LH）是胰岛素治疗最常见的并发症之一。我们在英国的18个中心开展了一项前瞻性研究，以评估针对性LH干预对一系列临床、生物学和社会经济参数的影响。
随机招募75名注射胰岛素的患者，并对其进行3至6个月的前瞻性随访，将结果与基线值进行比较。干预措施包括使用强化教育计划并改用4毫米笔用针头。
在研究结束时，所有注射部位的LH均显著下降，要么完全消失，要么直径从原来的大小缩小约50%。到研究结束时，在脂肪增生部位进行的注射减少了75%以上。大多数患者在开始时没有正确轮换注射部位，但到研究结束时，大多数患者做到了，比例提高了5倍。在研究开始时，只有1/3的受试者使用4毫米针头，然而，到研究结束时几乎所有人都使用了。平均糖化血红蛋白（HbA1c）改善超过4mmol/L，意外低血糖和血糖变异性水平显著降低。到研究结束时，胰岛素每日总剂量平均下降了5.6国际单位。
我们认为，通过广泛采用本研究中概述的干预措施，可以实现通过预防脂肪增生的培训所带来的令人瞩目的临床改善。
