Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes

Diabetes Metab. 2013 Oct;39(5):445-53. doi: 10.1016/j.diabet.2013.05.006. Epub 2013 Jul 22.


Introduction: Our objective was to assess the frequency of lipohypertrophy (LH) and its relationship to site rotation, needle reuse, glucose variability, hypoglycaemia and use of insulin.

Methods: The study included 430 outpatients injecting insulin who filled out a wide-ranging questionnaire regarding their injection technique. Then, a diabetes nurse examined their injection sites for the presence of LH.

Results: Nearly two-thirds (64.4%) of patients had LH. There was a strong relationship between the presence of LH and non-rotation of sites, with correct rotation technique having the strongest protective value against LH. Of the patients who correctly rotated sites, only 5% had LH while, of the patients with LH, 98% either did not rotate sites or rotated incorrectly. Also, 39.1% of patients with LH had unexplained hypoglycaemia and 49.1% had glycaemic variability compared with only 5.9% and 6.5%, respectively, in those without LH. LH was also related to needle reuse, with risk increasing significantly when needles were used > 5 times. Total daily insulin doses for patients with and without LH averaged 56 and 41 IU/day, respectively. This 15 IU difference equates to a total annual cost to the Spanish healthcare system of > €122 million. This was also the first study in which the use of ultrasound allowed the description of an "echo signature" for LH.

Conclusion: Correct injection site rotation appears to be the critical factor in preventing LH, which is associated with reduced glucose variability, hypoglycaemia, insulin consumption and costs.

Keywords: Consommation d’insuline; Costs; Coûts; Injection d’insuline; Injection rotation; Insulin consumption; Insulin injection; Lipodystrophie (LH); Lipodystrophy; Lipohypertrophy; Rotation d’injection.

Publication types

  • Multicenter Study

MeSH terms

  • Adipose Tissue / injuries
  • Adipose Tissue / pathology*
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Female
  • Glycated Hemoglobin / metabolism
  • Guidelines as Topic
  • Humans
  • Hypertrophy / epidemiology
  • Hypertrophy / etiology
  • Hypoglycemic Agents / administration & dosage*
  • Injections, Subcutaneous / adverse effects*
  • Insulin / administration & dosage*
  • Male
  • Middle Aged
  • Odds Ratio
  • Prevalence
  • Primary Health Care
  • Risk Factors
  • Spain / epidemiology
  • Young Adult


  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • hemoglobin A1c protein, human