title: Insulin antibodies are associated with lipoatrophy but also with lipohypertrophy in children and adolescents with type 1 diabetes.
abstract: OBJECTIVE
  To evaluate clinical and immunological factors that are associated with lipodystrophy, i.e. lipoatrophy and lipohypertrophy, in diabetic children and adolescents.
  
  
  METHODS
  We investigated in a cross-sectional study 112 children and adolescents (age 1.1-19.1 yrs.) with type 1 diabetes. To grade lipodystrophy, we developed a clinical score ranging from normal (grade 0), moderate hypertrophy of subcutaneous tissue (grade 1), severe hypertrophy with increased density of tissue (grade 2) to lipoatrophy (grade 3). In all children, grade of lipodystrophy, antibodies against insulin (IA) or beta cell antigens (IA-2 and GAD) and clinical parameters were documented.
  
  
  RESULTS
  The antibodies against insulin (IA) increased significantly after diabetes manifestation and initiation of insulin treatment, while beta cell specific antibodies (IA-2, GAD) did not. Lipoatrophy (grade 3) was seen in 4 children, severe lipohypertrophy (grade 2) in 18 and moderate lipohypertrophy (grade 1) in 27 children. No alteration of injection sites was found in 63 children. Amongst clinical and immunological parameters, IA levels were significantly associated with hypertrophy or atrophy of injection sites.
  
  
  CONCLUSIONS
  The strong association of lipoatrophy and lipohypertrophy with insulin antibodies might suggest that autoimmune phenomena with insulin play a role in the development of both. Despite an association of IA and lipodystrophy in type 1 diabetic children, the causal link between the two remains unproven and requires further longitudinal exploration.
authors.affiliation: Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany. raik@medizin.uni-leipzig.de
authors.forename: K
authors.initials: K
authors.lastname: Raile
authors.forename: V
authors.initials: V
authors.lastname: Noelle
authors.forename: R
authors.initials: R
authors.lastname: Landgraf
authors.forename: H P
authors.initials: HP
authors.lastname: Schwarz
mesh_terms: D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology*; D005968:Glutamate Decarboxylase / Q000276:immunology; D000949:Histocompatibility Antigens Class II / Q000276:immunology; D006801:Humans; D007223:Infant; D007328:Insulin / Q000276:immunology*; D008060:Lipodystrophy / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D000949:Histocompatibility Antigens Class II; C096322:ICA512 autoantibody; D007328:Insulin; D005968:Glutamate Decarboxylase