title: Lipoatrophy in children with type 1 diabetes: an increasing incidence?
abstract: The objectives were to evaluate the current prevalence of lipoatrophy at insulin injection sites in young patients with type 1 diabetes. Standardized examination of insulin injection sites in all 678 patients with type 1 diabetes treated in 2013 in our outpatient clinic were conducted. In case of lipoatrophy photo documentation and standardized interview with parents and patients were performed. We identified a total of 16 patients (43.8% male) with lipoatrophy (overall prevalence 2.4%). The current mean age (±SD) of the affected patients was 14.4 ± 3.9 years, age and diabetes duration at onset of lipoatrophy were 11.5 ± 3.8 years and 5.4 ± 3.6 years, respectively. All patients were using analogs at the onset of lipoatrophy. In all, 14 of 16 patients (87.5%) were on insulin pump compared with 52% without lipoatrophy (P = .0018). The use of steel needle and Teflon catheter was equal between the pump patients. Concomitant autoimmune diseases were present in 37.5% of the patients (thyroiditis: n = 3, thyroiditis and celiac disease: n = 2, celiac disease: n = 1) compared with 15.0% in those without lipoatrophy (P = .0128). Lipoatrophy was present in young patients treated with modern insulins and pumps; however, the prevalence was relatively low as expected with the use of modern insulins. Our data may support the hypothesis that a constant mechanical element such as a subcutaneous catheter may trigger the development of lipoatrophy, particularly in those patients with more than 1 autoimmune disease.
authors.affiliation: Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany kordonouri@hka.de.
authors.forename: Olga
authors.initials: O
authors.lastname: Kordonouri
authors.affiliation: Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany.
authors.forename: Torben
authors.initials: T
authors.lastname: Biester
authors.affiliation: Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schnell
authors.affiliation: Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hartmann
authors.affiliation: Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany.
authors.forename: Christiana
authors.initials: C
authors.lastname: Tsioli
authors.affiliation: Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany.
authors.forename: Maryam
authors.initials: M
authors.lastname: Fath
authors.affiliation: Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany.
authors.forename: Nicolin
authors.initials: N
authors.lastname: Datz
authors.affiliation: Diabetes Center for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Danne
mesh_terms: D000293:Adolescent; D001284:Atrophy / Q000139:chemically induced / Q000453:epidemiology; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000819:agonists*; D015994:Incidence; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects*; D007332:Insulin Infusion Systems; D008297:Male; D015995:Prevalence; D050151:Subcutaneous Fat / Q000473:pathology*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: CSII; catheters; injection sites; insulin analogs; lipoatrophy