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Lipoatrophy, a rare complication of diabetes: a single-center experience

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Abstract

Background

Lipoatrophy (LA), a rare skin complication in patients with type 1 diabetes (T1D), has decreased dramatically over the past decades due to the use of human purified insulin preparations.

Methods

We collected data from the records of T1D patients with LA. Types of insulin and insulin regimen, presence of eosinophilia, anti-insulin (IAA), anti-GAD, anti-IA2 autoantibodies, other autoimmune disorders, site of atrophy and its relationship to catheter, HbA1c at LA onset and after resolution, and different treatment modalities (i.e., change of insulin type or site, sodium cromoglycate (SCG) cream, cortisone cream or percutaneous injections, and laser treatment) were recorded.

Results

Thirteen out of 1200 T1D subjects (1%) presented with LA. The majority were on insulin pump using rapid-acting analogs. Twelve out of 13 patients had changed the type of insulin, and most of them had switched injection sites. Ten out of 13 patients used SCG cream and 7/10 showed complete/partial improvement. One patient used dexamethasone injection with improvement. Five patients showed self-improvement. In 3/7 patients who were receiving SCG, treatment was combined with change of insulin type (glulisine); however, in 1/3, the result should be attributed to concomitant laser treatment. In 4/7 patients, there was a clear, beneficial effect of SCG. In 1/4 with partial resolution of LA, laser treatment was used after SCG, which further improved the result.

Conclusions

LA is a rare skin complication seen even today with the use of insulin analogs. SCG alone or combined with change of insulin type seems to be the most effective treatment. Laser treatment is a promising new therapy.

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Abbreviations

TID:

Type 1 diabetes

LA:

Lipoatrophy

CSII:

Continuous subcutaneous insulin infusion

SCG:

Sodium cromoglycate

SC:

Subcutaneous

MDI:

Multiple daily injections

IAA:

Anti-insulin autoantibodies

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Authors and Affiliations

  1. Diabetes Center, A’ Department of Pediatrics, P&A Kyriakou Children’s Hospital, Athens, Greece

    Maria Xatzipsalti, Giannoula Kourousi, Konstantina Patouni, Sotiris Konstantakopoulos, Dimitris Delis & Andriani Vazeou

  2. Dermatology Private Office, Athens, Greece

    Hlias Alvertis

Authors
  1. Maria Xatzipsalti
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  2. Hlias Alvertis
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  3. Giannoula Kourousi
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  6. Dimitris Delis
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  7. Andriani Vazeou
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Contributions

M.X. wrote the manuscript and contributed to the data analysis. A.H. helped in the treatment, A.K. reviewed and edited the manuscript. K.P reviewed and edited the manuscript. S.K. reviewed and edited the manuscript. D.D. reviewed and edited the manuscript. A.V. designed the study, reviewed and edited the manuscript and is the guarantor of this work and, as such, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Maria Xatzipsalti.

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The study was approved by the Scientific Committee of Children’s Hospital P&A Kyriakou.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Xatzipsalti, M., Alvertis, H., Kourousi, G. et al. Lipoatrophy, a rare complication of diabetes: a single-center experience. Hormones 21, 61–69 (2022). https://doi.org/10.1007/s42000-021-00324-z

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  • DOI: https://doi.org/10.1007/s42000-021-00324-z

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