Relationship Between Lipohypertrophy, Glycemic Control, and Insulin Dosing: A Systematic Meta-Analysis

Mader, Julia K; Fornengo, Riccardo; Hassoun, Ahmed; Heinemann, Lutz; Kulzer, Bernhard; Monica, Magdalena; Nguyen, Trung; Sieber, Jochen; Renard, Eric; Reznik, Yves; Rys, Przemyslaw; Stozek, Anita; Wilmot, Emma G.

Abstract

Background: Lipohypertrophy is a common complication in patients with diabetes receiving insulin therapy. There is a lack of consensus regarding how much lipohypertrophy affects diabetes management. Our study aimed to assess the potential correlation between lipohypertrophy and glycemic control, as well as insulin dosing in patients with diabetes.

Methods: We performed a systematic review followed by a meta-analysis to collect data about glycemic control and insulin dosing in diabetic patients with and without lipohypertrophy. To identify relevant studies published in English, we searched medical databases (MEDLINE/PubMed, Embase, and CENTRAL) from 1990 to January 20, 2023. An additional hand-search of references was performed to retrieve publications not indexed in medical databases. Results of meta-analyses were presented either as prevalence odds ratios (pORs) or mean differences (MDs) with 95% confidence intervals (95% CIs). This study was registered on PROSPERO (CRD42023393103).

Results: Of the 5540 records and 240 full-text articles screened, 37 studies fulfilled the prespecified inclusion criteria. Performed meta-analyses showed that patients with lipohypertrophy compared with those without lipohypertrophy were more likely to experience unexplained hypoglycemia (pOR [95% CI] = 6.98 [3.30–14.77]), overall hypoglycemia (pOR [95% CI] = 6.65 [1.37–32.36]), and glycemic variability (pOR [95% CI] = 5.24 [2.68–10.23]). Patients with lipohypertrophy also had higher HbA1c (MD [95% CI] = 0.55 [0.23–0.87] %), and increased daily insulin consumption (MD [95% CI] = 7.68 IU [5.31–10.06]).

Conclusions: These results suggest that overall glycemic control is worse in patients with lipohypertrophy than in those without this condition.

Citation

Mader, J. K., Fornengo, R., Hassoun, A., Heinemann, L., Kulzer, B., Monica, M., Nguyen, T., Sieber, J., Renard, E., Reznik, Y., Rys, P., Stozek, A., & Wilmot, E. G. (2024). Relationship Between Lipohypertrophy, Glycemic Control, and Insulin Dosing: A Systematic Meta-Analysis. Diabetes Technology and Therapeutics, 26(5), 351-362. https://doi.org/10.1089/dia.2023.0491

• Journal Article Type: Review
• Acceptance Date: Jan 12, 2024
• Online Publication Date: Apr 30, 2024
• Publication Date: 2024-05
• Deposit Date: Feb 14, 2024
• Publicly Available Date: Jul 4, 2024
• Journal: Diabetes Technology and Therapeutics
• Print ISSN: 1520-9156
• Electronic ISSN: 1557-8593
• Publisher: Mary Ann Liebert
• Peer Reviewed: Peer Reviewed
• Volume: 26
• Issue: 5
• Pages: 351-362
• DOI: https://doi.org/10.1089/dia.2023.0491
• Keywords: Medical Laboratory Technology, Endocrinology, Endocrinology, Diabetes and Metabolism
• Public URL: https://nottingham-repository.worktribe.com/output/30105773
• Publisher URL: https://www.liebertpub.com/doi/10.1089/dia.2023.0491