Mader Julia K, Fornengo Riccardo, Hassoun Ahmed, Heinemann Lutz, Kulzer Bernhard, Monica Magdalena, Nguyen Trung, Sieber Jochen, Renard Eric, Reznik Yves, Ryś Przemysław, Stożek-Tutro Anita, Wilmot Emma G
Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Dipartimento di Area Medica, ASL TO4 S.S.D. di Diabetologia, Chivasso, Italy.
J Diabetes Sci Technol. 2025 Mar 20:19322968251325569. doi: 10.1177/19322968251325569.
Lipohypertrophy is a common skin complication in people with insulin-treated diabetes. Despite its high prevalence and potential impact on diabetes management and outcomes, published data regarding the risk factors for the development of this complication are contradictory. The study aimed to determine risk factors for lipohypertrophy related to patient characteristics and insulin therapy.
Medical databases (MEDLINE/PubMed, Embase, CENTRAL) were searched from 1990 to August 21, 2023. All relevant studies describing potential risk factors for lipohypertrophy in people with insulin-treated diabetes (eg, sex, age, body mass index [BMI], type of diabetes, and injection technique) were included. Data enabling calculations of prevalence odds ratios (pOR) and mean differences (MD) with 95% confidence intervals [95% CI] were extracted and pooled in meta-analyses.
Fifty-one studies of risk factors for lipohypertrophy were identified. Performed meta-analyses indicate that the strongest contributor to lipohypertrophy was incorrect injection site rotation (pOR = 8.85 [95% CI: 5.10-15.33]), followed by needle reuse (3.20 [1.99-5.13]), duration of insulin therapy >5 years (2.62 [1.70-4.04]) and >2 daily injections per day (2.27 [1.58-3.25]). Those with type 1 diabetes and obese/overweight individuals also had significantly higher odds of developing lipohypertrophy. Sex, age, and insulin device (pen, syringes) were not significant risk factors for lipohypertrophy.
This systematic review with meta-analysis revealed that incorrect injection site rotation and needle reuse are the most substantial factors in developing lipohypertrophy. Notably, both factors are modifiable through patient education, emphasizing the importance of teaching proper injection techniques for better diabetes management.
脂肪增生是接受胰岛素治疗的糖尿病患者常见的皮肤并发症。尽管其发病率高且对糖尿病管理及预后有潜在影响，但已发表的关于该并发症发生风险因素的数据相互矛盾。本研究旨在确定与患者特征和胰岛素治疗相关的脂肪增生风险因素。
检索了1990年至2023年8月21日的医学数据库（MEDLINE/PubMed、Embase、CENTRAL）。纳入所有描述接受胰岛素治疗的糖尿病患者脂肪增生潜在风险因素的相关研究（如性别、年龄、体重指数[BMI]、糖尿病类型和注射技术）。提取能够计算患病率比值比（pOR）和平均差（MD）及95%置信区间[95%CI]的数据，并汇总进行荟萃分析。
共确定了51项关于脂肪增生风险因素的研究。进行的荟萃分析表明，脂肪增生的最主要因素是注射部位轮换不当（pOR = 8.85 [95%CI：5.10 - 15.33]），其次是针头重复使用（3.20 [1.99 - 5.13]）、胰岛素治疗时长>5年（2.62 [1.70 - 4.04]）以及每天注射>2次（2.27 [1.58 - 3.25]）。1型糖尿病患者和肥胖/超重个体发生脂肪增生的几率也显著更高。性别、年龄和胰岛素注射装置（笔式注射器、注射器）不是脂肪增生的显著风险因素。
这项荟萃分析的系统评价表明，注射部位轮换不当和针头重复使用是导致脂肪增生的最重要因素。值得注意的是，这两个因素都可通过患者教育加以改善，强调教授正确注射技术对更好地管理糖尿病的重要性。
