title: Differences in depression, treatment satisfaction and injection behaviour in adults with type 1 diabetes and different degrees of lipohypertrophy.
abstract: OBJECTIVE
  To assess the prevalence of lipohypertrophy, and to compare differences in external, personal and regimen factors in adults with type 1 diabetes and different degrees of lipohypertrophy.
  
  
  BACKGROUND
  Suboptimal insulin injection behaviour is associated with lipohypertrophy, which may affect insulin absorption and lead to blood glucose fluctuations. Few, if any studies have investigated how external, personal and regimen factors differ in people with type 1 diabetes and different degrees of lipohypertrophy.
  
  
  METHODS
  A cross-sectional study including adults with type 1 diabetes at a diabetes outpatient clinic in a Norwegian university hospital.
  
  
  METHODS
  Participants (n = 215) were included consecutively at scheduled appointments. Sociodemographic, diabetes and insulin treatment data, and self-report questionnaires concerning patient activation (Patient Activation Measure), depression (Patient Health Questionnaire-2), diabetes distress (Diabetes Distress Scale), type D personality (14-item Type D scale), treatment satisfaction (Insulin Treatment Satisfaction Questionnaire) and motivation (Treatment Self-Regulation Questionnaire), were collected. Lipohypertrophic injection sites were identified by palpation by diabetes specialist nurses.
  
  
  RESULTS
  Lipohypertrophy was present in 53% and was more frequent in insulin pen users (63%) compared to insulin pump users (34%). Participants with two or more lipohypertrophic areas had higher depression scores, lower treatment satisfaction with glycaemic control, higher bolus doses and reported suboptimal injection behaviour compared to those with no lipohypertrophic areas. There were no differences in patient activation, diabetes distress, type D personality or motivation between the groups.
  
  
  CONCLUSIONS
  Compared to pump treatment, pen treatment requires greater awareness of injection technique. Symptoms of depression and lower treatment satisfaction might affect diabetes self-management and glycaemic control, but the association with lipohypertrophy needs further exploration.
  
  
  CONCLUSIONS
  Lipohypertrophy is more frequent in insulin pen users compared to pump users. Nurses should focus on injection technique education, and should also consider screening for depressive symptoms and treatment satisfaction as these factors could be associated with development of lipohypertrophy.
authors.affiliation: Department of Medicine, Haukeland University Hospital, Bergen, Norway.|Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.
authors.forename: Ingvild
authors.identifier: http://orcid.org/0000-0001-7185-6234
authors.initials: I
authors.lastname: Hernar
authors.affiliation: Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.
authors.forename: Johannes
authors.initials: J
authors.lastname: Haltbakk
authors.affiliation: Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway.|Department of Nursing Science, Jönköping University, Jönköping, Sweden.|Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Broström
mesh_terms: D000273:Adipose Tissue / Q000187:drug effects / Q000473:pathology*; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000523:psychology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000451:nursing / Q000523:psychology; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000139:chemically induced / Q000473:pathology; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007332:Insulin Infusion Systems / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D057566:Self Report
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: depressive symptoms; diabetes specialist nurses; health behaviour; insulin injection therapy; lipohypertrophy; self-assessment tools; self-management of injection technique; treatment satisfaction; type 1 diabetes