Acta Diabetologica

, Volume 55, Issue 1, pp 67–73 | Cite as

Errors in insulin treatment management and risk of lipohypertrophy

  • Giuseppe Maria PozzuoliEmail author
  • Mario Laudato
  • Maria Barone
  • Franco Crisci
  • Bianca Pozzuoli
Original Article



Lipohypertrophy (LH) represents the most common skin-related complication associated with insulin therapy. Our aim is to estimate the prevalence of LH among insulin-treated patients, to identify its association with errors in insulin injection technique and storage, and the correlation between LH, risk of hypoglycemia, and glycemic control.


Consecutive patients with T1DM or T2DM, attending a diabetes clinic for a routine visit, were administered an anonymous questionnaire investigating the modalities of insulin injection, the correct use of pen device, insulin storage, and reported frequency of hypoglycemic episodes. The presence of LH was assessed by inspection and palpation of injection sites.


Overall, 352 patients were enrolled (mean age 68 ± 12 years, 43.2% males, 88.9% with T2DM, mean duration of insulin therapy 9.1 ± 8.6 years). The prevalence of LH was 42.9%. At multivariate analysis, the strongest correlates of LH were not spacing injections (OR 20.4; 95% CI 10.5–39.6) and not rotating the site of injection (OR 2.01; 95% CI 1.08–3.75). Increasing doses of insulin and longer duration of insulin therapy also increased the risk of LH. The presence of LH was associated with a 2.7 times higher risk of severe hypoglycemia. Higher daily insulin doses, lack of rotation of injection sites, and keeping insulin in use in the refrigerator were independent correlates of higher HbA1c levels.


Insulin injection technique is suboptimal in many patients, highlighting the need for improved patient education. Increasing the awareness of the importance of preventing lipohypertrophy and insulin injection errors represents an important tool to reduce the clinical, social, and economic burden of diabetes.


Lipohypertrophy Insulin injection technique Hypoglycemia Metabolic control 


Compliance with ethical standards

Conflict of interest


Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the 1975 Declaration of Helsinki, as revised in 2008 (5).

Informed consent

Informed consent was obtained from all patients for being included in the study.

Supplementary material

592_2017_1066_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 15 kb)


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Copyright information

© Springer-Verlag Italia S.r.l. 2017

Authors and Affiliations

  1. 1.Azienda Sanitaria Locale Caserta, Centro DiabetologicoCasertaItaly
  2. 2.Università degli Studi Della Campania: L. Vanvitelli. Corso di Laurea in Infermieristica. ASL CEMaddaloniItaly

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