Luo Dan, Shi Yun, Zhu Min, Wang Hong, Yan Dan, Yu Jian, Ji JiaJia, Liu Xiaoyun, Fan Boqiang, Xu Yang, Zhang Mei, He Wei, Xu Jingjing, Yang Tao
School of Nursing, Nanjing Medical University, 101 Longmian Dadao, Jiangning District, Nanjing, China.
Department of Endocrinology, First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), 300 Guangzhou Road, Gulou District, Nanjing, China.
J Diabetes Complications. 2021 Mar;35(3):107806. doi: 10.1016/j.jdiacomp.2020.107806. Epub 2020 Nov 26.
Subclinical lipohypertrophy is a lesion meeting ultrasonic criteria for lipohypertrophy that was not detected by inspection and palpation. Little information is published on subclinical lipohypertrophy among insulin injection people with diabetes. We aimed to investigate the subclinical lipohypertrophy prevalence, risk factors, and the association between subclinical lipohypertrophy and glycemic control.
This observational study included 316 people with diabetes who had continuously received insulin therapy for at least one year. We performed ultrasound scanning and clinical examination for evidence of subclinical lipohypertrophy. Demographic characteristics, clinical information, and glycated hemoglobin were measured.
The overall prevalence of subclinical lipohypertrophy was 19.9%. By stepwise logistic regression, higher BMI (OR = 1.44, 95%CI: 1.15-1.81, P = 0.002), incorrect rotation of sites (OR = 3.11, 95%CI: 1.02-9.47, P = 0.046), insulin needle reusage for more than four times (OR = 10.00, 95%CI: 3.23-31.02, P = 0.000) and type 1 diabetes (OR = 6.33, 95%CI: 1.32-30.47, P = 0.021) remained associated with subclinical lipohypertrophy. Subclinical lipohypertrophy demonstrated a significant independent correlation with the nonoptimal glycemic control (OR = 9.97, 95% CI: 3.46-28.75, P = 0.000) when accounting for demographic and diabetes-related parameters.
Subclinical lipohypertrophy is common among insulin-injecting patients with diabetes and is related to glycemic control deterioration. Ultrasonography may be an ideal adjunct in the evaluation of easily ignored lipohypertrophy lesions, especially where poor glycemic control, incorrect injection behaviors, overweight or obesity are documented.
亚临床脂肪增生是一种符合脂肪增生超声标准但通过视诊和触诊未检测到的病变。关于糖尿病胰岛素注射人群中亚临床脂肪增生的报道较少。我们旨在调查亚临床脂肪增生的患病率、危险因素以及亚临床脂肪增生与血糖控制之间的关联。
这项观察性研究纳入了316名持续接受胰岛素治疗至少一年的糖尿病患者。我们进行了超声扫描和临床检查以寻找亚临床脂肪增生的证据。测量了人口统计学特征、临床信息和糖化血红蛋白。
亚临床脂肪增生的总体患病率为19.9%。通过逐步逻辑回归分析，较高的体重指数（OR = 1.44，95%CI：1.15 - 1.81，P = 0.002）、部位轮换不正确（OR = 3.11，95%CI：1.02 - 9.47，P = 0.046）、胰岛素针头重复使用超过四次（OR = 10.00，95%CI：3.23 - 31.02，P = 0.000）以及1型糖尿病（OR = 6.33，95%CI：1.32 - 30.47，P = 0.021）仍与亚临床脂肪增生相关。在考虑人口统计学和糖尿病相关参数时，亚临床脂肪增生与血糖控制不佳存在显著的独立相关性（OR = 9.97，95%CI：3.46 - 28.75，P = 0.000）。
亚临床脂肪增生在糖尿病胰岛素注射患者中很常见，并且与血糖控制恶化有关。超声检查可能是评估易被忽视的脂肪增生病变的理想辅助手段，尤其是在记录有血糖控制不佳、注射行为不正确、超重或肥胖的情况下。
