Background

Subcutaneous insulin therapy is associated with important injection site complications, which can influence insulin pharmacokinetics resulting in glycemic fluctuations above and below target levels for blood glucose.

Objective

Our objective was to assess the prevalence and risk factors of cutaneous complications including insulin derived amyloidosis in insulin-injecting diabetes patients and to study the role of ultrasonography (in comparison to gel-assisted palpation) in early diagnosis of lipohypertrophy (LH).

Methods

This was a cross-sectional study conducted at a tertiary care center in India, wherein 500 patients injecting insulin for ≥2 years were randomly enrolled and evaluated for the presence of cutaneous complications of insulin therapy through clinical examination, ultrasonography and punch biopsy of skin.

Results

Clinical examination detected LH in 44.6% of patients. Ultrasonography diagnosed additional 13.4% of patients with LH which were missed on clinical examination. Incorrect rotation of sites (P < 0.001) and insulin syringe reusage for more than five times (P < 0.001) significantly increased the risk of LH. Skin biopsy was performed in 100 cases, out of which two patients showed apple green birefringence and its association with insulin was confirmed by positive staining with anti insulin antibody in these two patients.

Conclusion

Improper rotation of sites and reuse of needles were the leading causes of LH in Indian diabetic patients. Ultrasonography is more objective and reliable method of detecting LH. Insulin-derived amyloidosis may be a more common complication of insulin therapy than previously thought.

中文翻译：

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早期发现胰岛素治疗在 1 型和 2 型糖尿病中的皮肤并发症

背景

皮下胰岛素治疗与重要的注射部位并发症有关，这会影响胰岛素药代动力学，导致血糖波动高于和低于血糖目标水平。

客观的

我们的目的是评估注射胰岛素的糖尿病患者中包括胰岛素衍生淀粉样变性在内的皮肤并发症的发生率和危险因素，并研究超声检查（与凝胶辅助触诊相比）在脂肪肥大 (LH) 早期诊断中的作用。

方法

这是一项在印度三级护理中心进行的横断面研究，其中随机招募了 500 名注射胰岛素≥2 年的患者，并通过临床检查、超声检查和皮肤穿刺活检评估胰岛素治疗的皮肤并发症。

结果

临床检查在 44.6% 的患者中检测到 LH。超声检查诊断出另外 13.4% 的 LH 患者错过了临床检查。部位旋转不正确（P < 0.001）和胰岛素注射器重复使用超过五次（P < 0.001）显着增加了 LH 的风险。100例皮肤活检，其中2例呈现苹果绿双折射，这2例患者抗胰岛素抗体阳性染色证实其与胰岛素相关。

结论

部位旋转不当和针头重复使用是印度糖尿病患者 LH 的主要原因。超声检查是检测 LH 较为客观可靠的方法。胰岛素衍生的淀粉样变性可能是胰岛素治疗的一种比以前认为的更常见的并发症。