Diabetes Unit, SSD Diabetologia, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
SS Diabetologia, Bassini Hospital, Cinisello Balsamo, Milan, Italy.
J Endocrinol Invest. 2017 Oct;40(10):1107-1113. doi: 10.1007/s40618-017-0675-1. Epub 2017 Apr 27.
Subcutaneous insulin absorption is one of the key factors affecting glycemic control in patients with diabetes mellitus under insulin therapy. Insulin-induced subcutaneous lipohypertrophy has been reported to impair insulin regular absorption and hence glycemic control. So far, lipohypertrophy diagnosis has only been clinical. This study aims at evaluating the possible role of ultrasound scan in the assessment of subcutaneous lipohypertrophy in patients affected by type 1 diabetes mellitus.
A pilot observational retrospective study was performed in 20 patients affected by type 1 diabetes mellitus. In these patients the areas with clinical evidence of lipohypertrophy dependent on the insulin injections were characterized by the presence of tissues that at the ultrasound scan resulted similar to fibrotic tissues (hyperechogenic) or to an interstitial edema or to fat tissues (hypoechogenic). It was utilized a multi frequency linear probe (6-18 MHz). The patients were advised to avoid insulin injections on the areas with lipohypertrophy scanned by the ultrasound and the HbA1c changes were evaluated 3 months later.
The lipohypertrophic areas presented at least three different aspects upon ultrasound assessment: the iso-hyperechogenic one, with a predominant fibrotic component; the isoechogenic one, with "large tangles" fibrotic elements and the iso-hypoechogenic aspect with no fibrotic elements. When patients were advised to avoid insulin injections on areas with lipohypertrophy defined by ultrasound scan, 3 months after the first evaluation HbA1c had significantly improved (basal HbA1c 7.87 ± 0.56 versus 7.67 ± 0.52 3 months later, p = 0.029). No significant improvements of the HbA1c were found in the control matched group in which lipohypertrophy was only clinically valued through inspection and palpation.
Ultrasound scan can help identify and characterize the lipohypertrophic areas and this might be useful to improve glycemic control.
皮下胰岛素吸收是接受胰岛素治疗的糖尿病患者血糖控制的关键因素之一。已有报道称，胰岛素引起的皮下脂肪肥厚会损害胰岛素的常规吸收，从而影响血糖控制。到目前为止，脂肪肥厚的诊断仅为临床诊断。本研究旨在评估超声扫描在评估 1 型糖尿病患者皮下脂肪肥厚中的可能作用。
对 20 例 1 型糖尿病患者进行了一项前瞻性观察性回顾性研究。在这些患者中，根据胰岛素注射部位出现的临床脂肪肥厚证据，通过超声检查，将这些部位的组织特征描述为类似纤维组织（高回声）或间质水肿或脂肪组织（低回声）。使用多频线性探头（6-18MHz）。建议患者避免在超声扫描的脂肪肥厚部位注射胰岛素，并在 3 个月后评估 HbA1c 的变化。
脂肪肥厚区域在超声评估中至少呈现出三种不同的方面：等回声型，以纤维成分为主；等回声型，有“大纠结”纤维成分；等低回声型，无纤维成分。当患者被建议避免在超声扫描定义的脂肪肥厚部位注射胰岛素时，首次评估 3 个月后，HbA1c 显著改善（基础 HbA1c 为 7.87±0.56，3 个月后为 7.67±0.52，p=0.029）。在对照组中，仅通过检查和触诊评估脂肪肥厚，HbA1c 无明显改善。
超声扫描可以帮助识别和描述脂肪肥厚区域，这可能有助于改善血糖控制。
