title: UK lipohypertrophy interventional study.
abstract: BACKGROUND
  Lipohypertrophy (LH) is one of the most common complications of insulin therapy. We conducted a prospective study in 18 UK centres to assess the impact of a targeted LH intervention on a range of clinical, biological and socio-economic parameters.
  
  
  METHODS
  Seventy-five insulin-injecting patients were recruited randomly and were followed prospectively for 3-6months, with results compared to baseline values. Interventions included the use of an intensive education program and a switch to a 4mm pen needle.
  
  
  RESULTS
  At all injection sites LH decreased significantly by the end of the study, either disappearing completely or shrinking by approximately 50% from its original diameter. Injections into LH decreased by more than 75% by the end. Most patients were not correctly rotating injection sites at the beginning but by the end most were, by a 5-fold margin. Only 1/3 of our subjects used the 4mm needle at the beginning of the study, however, virtually all did by study end. The mean HbA1c improved by more than 4mmol/L and there were significantly lower levels of unexpected hypoglycaemia and glucose variability. Total daily doses of insulin dropped by an average of 5.6 IU by study end.
  
  
  CONCLUSIONS
  We believe the impressive clinical improvements seen with training to prevent LH can be achieved by wide adoption of the interventions outlined in this study.
authors.affiliation: BD Diabetes Care, The Danby Building, Edmund Halley Road, Oxford Science Park, Oxford OX4 4DQ, UK. Electronic address: mike_smith@europe.bd.com.
authors.forename: Mike
authors.initials: M
authors.lastname: Smith
authors.affiliation: Wharfedale Diabetes Centre, Wharfedale Hospital, Newall Carr Road, Otley, Leeds Teaching Hospitals, LS21 2LY Leeds, UK. Electronic address: linda.clapham@hotmail.co.uk.
authors.forename: Linda
authors.initials: L
authors.lastname: Clapham
authors.affiliation: BD Diabetes Care, POB 13, Erembodegem-Dorp 86, B-9320 Erembodegem, Belgium. Electronic address: kenneth_strauss@europe.bd.com.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Strauss
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000139:chemically induced; D007003:Hypoglycemia / Q000188:drug therapy; D007279:Injections, Subcutaneous / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects*; D052439:Lipid Metabolism Disorders / Q000139:chemically induced* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011446:Prospective Studies; D012648:Self Care / Q000379:methods; D050151:Subcutaneous Fat / Q000187:drug effects / Q000473:pathology*; D006113:United Kingdom
chemical_list: D007328:Insulin
keywords: Injections; Insulin; Lipodystrophy; Lipohypertrophy; Needles; Subcutaneous