Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.
J Clin Nurs. 2017 Dec;26(23-24):4583-4596. doi: 10.1111/jocn.13801. Epub 2017 May 31.
To assess the prevalence of lipohypertrophy, and to compare differences in external, personal and regimen factors in adults with type 1 diabetes and different degrees of lipohypertrophy.
Suboptimal insulin injection behaviour is associated with lipohypertrophy, which may affect insulin absorption and lead to blood glucose fluctuations. Few, if any studies have investigated how external, personal and regimen factors differ in people with type 1 diabetes and different degrees of lipohypertrophy.
A cross-sectional study including adults with type 1 diabetes at a diabetes outpatient clinic in a Norwegian university hospital.
Participants (n = 215) were included consecutively at scheduled appointments. Sociodemographic, diabetes and insulin treatment data, and self-report questionnaires concerning patient activation (Patient Activation Measure), depression (Patient Health Questionnaire-2), diabetes distress (Diabetes Distress Scale), type D personality (14-item Type D scale), treatment satisfaction (Insulin Treatment Satisfaction Questionnaire) and motivation (Treatment Self-Regulation Questionnaire), were collected. Lipohypertrophic injection sites were identified by palpation by diabetes specialist nurses.
Lipohypertrophy was present in 53% and was more frequent in insulin pen users (63%) compared to insulin pump users (34%). Participants with two or more lipohypertrophic areas had higher depression scores, lower treatment satisfaction with glycaemic control, higher bolus doses and reported suboptimal injection behaviour compared to those with no lipohypertrophic areas. There were no differences in patient activation, diabetes distress, type D personality or motivation between the groups.
Compared to pump treatment, pen treatment requires greater awareness of injection technique. Symptoms of depression and lower treatment satisfaction might affect diabetes self-management and glycaemic control, but the association with lipohypertrophy needs further exploration.
Lipohypertrophy is more frequent in insulin pen users compared to pump users. Nurses should focus on injection technique education, and should also consider screening for depressive symptoms and treatment satisfaction as these factors could be associated with development of lipohypertrophy.
评估 1 型糖尿病患者脂肪肥厚的发生率，并比较不同程度脂肪肥厚患者的外部、个人和方案因素的差异。
胰岛素注射行为不当与脂肪肥厚有关，这可能会影响胰岛素吸收，导致血糖波动。很少有研究调查过 1 型糖尿病患者脂肪肥厚程度不同的患者在外部、个人和方案因素方面有何不同。
这是一项在挪威大学附属医院糖尿病门诊进行的横断面研究，纳入了成年人 1 型糖尿病患者。
患者（n=215）连续在预约时纳入。收集了社会人口统计学、糖尿病和胰岛素治疗数据，以及患者激活（患者激活量表）、抑郁（患者健康问卷-2）、糖尿病困扰（糖尿病困扰量表）、D 型人格（14 项 D 型量表）、治疗满意度（胰岛素治疗满意度问卷）和动机（治疗自我调节问卷）的自我报告问卷。由糖尿病专科护士通过触诊确定脂肪肥厚的注射部位。
脂肪肥厚的发生率为 53%，使用胰岛素笔的患者（63%）比使用胰岛素泵的患者（34%）更常见。与无脂肪肥厚区域的患者相比，有两个或更多脂肪肥厚区域的患者抑郁评分更高，血糖控制治疗满意度更低，大剂量胰岛素注射更频繁，并且报告注射行为不当。两组患者的患者激活、糖尿病困扰、D 型人格或动机无差异。
与泵治疗相比，笔治疗需要更高的注射技术意识。抑郁症状和治疗满意度降低可能会影响糖尿病自我管理和血糖控制，但与脂肪肥厚的关联需要进一步探讨。
与泵治疗相比，胰岛素笔治疗患者脂肪肥厚更常见。护士应重点关注注射技术教育，还应考虑筛查抑郁症状和治疗满意度，因为这些因素可能与脂肪肥厚的发生有关。
