Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research, Kolkata, India.
Department of Pathology, ESI-PGIMSR &ESIC Medical College, Kolkata, India.
J Pediatr Endocrinol Metab. 2021 Mar 4;34(4):503-508. doi: 10.1515/jpem-2020-0556. Print 2021 Apr 27.
Insulin-induced lipodystrophy is of two types, lipohypertrophy and lipoatrophy. Lipodystrophy often leads to worsening of glycemic control in type 1 diabetes mellitus. Our objective was to identify the clinical, immunological, and other factor(s) associated with the development of lipodystrophy.
In this observational cross-sectional hospital-based study, 95 children, adolescents, and young adults with type 1 diabetes mellitus were observed for the development of lipodystrophy. Injection technique, insulin dose, and glycemic parameters were noted. Serum TNF-α, IL-1β, and anti-insulin antibody levels were measured. Histopathological examination of the lipodystrophic area was done in a small number of people.
Among the participants, 45.2% of participants had lipohypertrophy and 4.2% had lipoatrophy exclusively; 3.1% of participants had coexisting lipohypertrophy and lipoatrophy. Improper injection site rotation technique was more common in participants with lipohypertrophy in comparison to those without lipodystrophy. The age of onset of diabetes, duration of insulin use, and the number of times of needle reuse were not significantly different between the lipohypertrophy and nonlipodystrophy groups. Serum TNF-α, IL-1β, and anti-insulin antibody levels; HbA; rate of hypoglycemia; and body weight-adjusted dose requirement were higher among the participants with lipohypertrophy. On histopathology, scant, or no inflammatory infiltrate was found in lipoatrophic and lipohypertrophic areas, respectively.
Improper insulin injection technique and higher levels of proinflammatory cytokines and anti-insulin antibody are associated with lipodystrophy in type 1 diabetes mellitus. HbA and rate of hypoglycemia are higher in people with lipodystrophy.
胰岛素引起的脂肪营养不良有两种类型，脂肪增生和脂肪萎缩。脂肪营养不良常导致 1 型糖尿病患者血糖控制恶化。我们的目的是确定与脂肪营养不良发展相关的临床、免疫和其他因素。
在这项观察性横断面医院基础研究中，观察了 95 名 1 型糖尿病儿童、青少年和年轻人脂肪营养不良的发展。记录了注射技术、胰岛素剂量和血糖参数。测量了血清 TNF-α、IL-1β 和抗胰岛素抗体水平。对少数脂肪营养不良区域进行了组织病理学检查。
在参与者中，45.2%的参与者有脂肪增生，4.2%的参与者有单纯性脂肪萎缩；3.1%的参与者同时存在脂肪增生和脂肪萎缩。与无脂肪营养不良的参与者相比，脂肪增生的参与者更常出现不当的注射部位轮换技术。糖尿病发病年龄、胰岛素使用时间和针头重复使用次数在脂肪增生和非脂肪营养不良组之间无显著差异。脂肪增生组的血清 TNF-α、IL-1β 和抗胰岛素抗体水平、HbA、低血糖发生率和体重调整后的剂量需求较高。在组织病理学上，脂肪萎缩和脂肪增生区域分别发现稀少或无炎症浸润。
不当的胰岛素注射技术以及较高水平的促炎细胞因子和抗胰岛素抗体与 1 型糖尿病的脂肪营养不良有关。脂肪营养不良患者的 HbA 和低血糖发生率较高。
