title: Frequency of Lipohypertrophy and Associated Risk Factors in Young Patients with Type 1 Diabetes: A Cross-Sectional Study.
abstract: BACKGROUND
  The objective of this study was to investigate the frequency of lipohypertrophy (LH) and the associated risk factors in young patients with type 1 diabetes mellitus (T1DM).
  
  
  METHODS
  This cross-sectional study was conducted on a sample of 174 patients with T1DM (aged 13-18 years) treated with multiple daily insulin injections for a minimum duration of 1 year. The study was performed at the Diabetes Treatment Center, Prince Sultan Military Medical City (Riyadh, Saudi Arabia), between July 2015 and September 2015. Information regarding patients' age, weight, height, adjusted body mass index (BMI), period of the diabetic condition, length of needle used, number of injections per day, injection locations, insulin regimen, and glycosylated hemoglobin (HbA1c) were recorded. LH was assessed using the palpation technique.
  
  
  RESULTS
  Nearly 46% of patients were found to reuse needles, while 42.5% failed to alternate the injection site and 23% revealed unexplained hypoglycemic events. A substantial percentage of patients (approximately 47%) showed grade 1 LH, followed by 33.7% with grade 2 and 19.3% with grade 3 LH. A higher frequency of LH was observed in the thigh region (n = 28, 33.7%) than in the arm, which was second highest (n = 23, 27.7%). Patients aged ≥16 years showed a higher frequency of LH than those aged <16 years. Patients with uncontrolled diabetes mellitus had a greater likelihood of having LH (59.5%) than those with controlled diabetes (20.8%). Significant differences in LH were observed based on needle length, needle reuse, and rotation of the injection sites. On performing regression analysis, the independent risk factors for LH were found to be as follows: higher BMI, higher HbA1c, a higher number of injection sites, a higher rate of needle reuse and failed to alternate the injection site.
  
  
  CONCLUSIONS
  As the frequency of LH was found to be high in Saudi patients with T1DM, it is essential to educate patients on the risk factors for LH and on diabetic control.
authors.affiliation: Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. ayman.alhayek@yahoo.com.
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Al Hayek
authors.affiliation: Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: Asirvatham A
authors.initials: AA
authors.lastname: Robert
authors.affiliation: Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: Rim B
authors.initials: RB
authors.lastname: Braham
authors.affiliation: Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Al Dawish
keywords: Glycemic control; Lipohypertrophy; Needle reuse; Saudi Arabia; Type 1 diabetes mellitus