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Diabetology
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Insulin Injection Techniques and Skin Lipodystrophy
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Insulin Injection Techniques and Skin Lipodystrophy

A special issue of Diabetology (ISSN 2673-4540).

Deadline for manuscript submissions: 30 June 2025 | Viewed by 2342

Special Issue Editors

Dr. Sandro Gentile

E-Mail Website
Guest Editor
1. Emeritus Professor of Internal Medicine, Department of Precision Medicine, Vanvitelli University of Naples, Naples, Italy
2. Research Director of Nefrocenter Research Network, Torre del Greco, Naples, Italy
Interests: diabetes; metabolism; endocrinology; hypertension; metabolic diseases; blood pressure; atherosclerosis; nutrition; internal medicines; insulin resistance; lipid metabolism; nutraceuticals; medical aerospace
Dr. Felix Strollo

E-Mail Website
Guest Editor
Endocrinology and Diabetes Department, IRCCS, San Raffaele Pisana, 00163 Rome, Italy
Interests: diabetes; metabolism; endocrinology; hypertension; metabolic diseases; blood pressure; atherosclerosis; nutrition; internal medicines; insulin resistance; lipid metabolism; nutraceuticals; medical aerospace
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The most frequent local complications of insulin injection are subcutaneous nodules due to incorrect injection techniques called lipodystrophies (LD). Injection into nodules has a series of negative consequences for glycemic control and variability, the frequency of severe hypoglycemia, the economic burden of diabetes, and the quality of life of patients with diabetes.

Guidelines and expert consensuses on injection techniques have appeared in the literature, and case series, surveys, and clinical trials concerning this topic are published continuously. Nevertheless, unfortunately, LD frequency remains dramatically high, mercilessly decreeing a defeat for healthcare providers. Common misconceptions, prejudices, educational deficiencies, and much more influence the incorrect injection behavior of people with diabetes, and a flawed or, even worse, incorrect approach to the problem by healthcare professionals is also, at least partly, responsible for such neglected insulin treatment complications.

These aspects deserve attention and represent a call to integrated action by educators, clinicians, researchers, and people with diabetes to correctly address a behavioral defect responsible for severe short- and long-term consequences for the latter and enormously increased costs for national health systems worldwide.

The Editorial Board invites you to send your contributions in the form of commentaries, short communications, research papers, clinical trials, case series, or surveys to provide readers with a timely update on insulin-induced lipodystrophies.

Dr. Sandro Gentile
Dr. Felix Strollo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diabetology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diabetes
  • insulin treatment
  • injection technique
  • skin complications
  • acquired lipodystrophy

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Published Papers (2 papers)

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Research

12 pages, 852 KiB  
Article
Prescribed Total Daily Insulin Dose and Predictors of Insulin Dose for Adults with Type 2 Diabetes on Multiple Daily Injections of Insulin: A Retrospective Cohort Study
by Eugene E. Wright, Jr., Viral N. Shah, Eden Miller, Andrew Thach, Pasha Javadi, Shawn Davies and Ray Sieradzan
Diabetology 2025, 6(2), 13; https://doi.org/10.3390/diabetology6020013 - 12 Feb 2025
Viewed by 822
Abstract
Background/Objectives: Limited evidence is available regarding insulin total daily dose (TDD), or the factors associated with TDD, among adults with type 2 diabetes (T2D) using multiple daily injections of insulin (MDI). Our aim was to determine the percentage of adults in the [...] Read more.
Background/Objectives: Limited evidence is available regarding insulin total daily dose (TDD), or the factors associated with TDD, among adults with type 2 diabetes (T2D) using multiple daily injections of insulin (MDI). Our aim was to determine the percentage of adults in the United States (US) with T2D who are prescribed MDI, their prescribed insulin TDD, and potential factors associated with TDD. Methods: This retrospective cohort study used deidentified data from the US IQVIA ambulatory electronic medical record database to study adults (≥18 years) with T2D initiating MDI (≥3 daily basal-plus-prandial insulin injections) from 1 January 2017 to 1 July 2022. The TDD was calculated from first evidence of MDI (index date). We used a generalized linear model regression analysis to model the relationship between TDD and clinically relevant factors associated with TDD. Results: During the study period, of 3,339,663 adults with T2D, 451,769 (13.5%) had ≥1 basal insulin prescriptions, 206,000 (6.2%) had both basal and prandial insulin prescriptions, and 41,215 (1.2%) were prescribed MDI (mean age, 58 years; 52% women; 62% White/Caucasian, 14% African American; mean body mass index [BMI], 34 kg/m2). Mean TDD was 96 units (1.0 units/kg/day); median TDD was 80 units (interquartile range, 54–124). In the regression analysis (model R2, 0.14), factors predicting lower TDD included female sex, African American race, and prior 6-month (pre-index) prescriptions of sulfonylurea, metformin, or 2–3 noninsulin glucose-lowering medications. Predictors of greater TDD included increasing BMI, age 30–64 years, and pre-index SGLT2 inhibitor or GLP-1 RA prescription. Conclusions: Among US adults with T2D, 1.2% were prescribed MDI, with a wide range of TDD and median TDD of 80 units. Further research in other populations and using other data sources is warranted to explore prescribed insulin TDD for T2D and to examine other potentially relevant predictors of TDD. Full article
(This article belongs to the Special Issue Insulin Injection Techniques and Skin Lipodystrophy)
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18 pages, 5033 KiB  
Article
Insulin-Related Skin Lipohypertrophy in Type Two Diabetes: A Clinical Study of a Case Series, with Ultrasonographic and Histopathologic Implications
by Sandro Gentile, Felice Strollo, Giuseppina Guarino, Andrea Ronchi, Ersilia Satta, Teresa Della-Corte, Elisabetta Fulgione, Graziella Babino, Edi Mattera, Emilia Martedì, Roberta Di Martino, Raffaella Fiorentino, Roberta Porcini, Carmine Romano, Maria Chiarello, Giuseppe Caccavale, Renato Franco and Giuseppe Argenziano
Diabetology 2024, 5(7), 725-742; https://doi.org/10.3390/diabetology5070053 - 20 Dec 2024
Cited by 1 | Viewed by 850
Abstract
Introduction: The most frequent local complication of insulin injection is the occurrence of subcutaneous nodules due to incorrect injection technique. Injection into nodules negatively impacts metabolic compensation and the requirement for greater insulin doses due to its partial and erratic absorption. Despite these [...] Read more.
Introduction: The most frequent local complication of insulin injection is the occurrence of subcutaneous nodules due to incorrect injection technique. Injection into nodules negatively impacts metabolic compensation and the requirement for greater insulin doses due to its partial and erratic absorption. Despite these concepts being accepted by the scientific community, it is not yet clear whether injection into nodules is causally related to worsening chronic diabetes (DM) complications and the morphological nature of such nodules. Aim: This multicenter study aimed to evaluate the associations between structural characteristics of skin nodules and chronic DM complications. A secondary endpoint was to evaluate the histological structure of those nodules, looking for differences between lipohypertrophies (LH) and amyloid nodules (LIDA). Methods: For this purpose, 816 DM patients with LH and 1033 without LH underwent a clinical and ultrasound study comparing metabolic data, injection habits, and frequency of complications. Excisional biopsies of the skin nodules were performed in a small series of eight subjects. Results: Data observed confirm a strong relationship between LH and diabetes chronic complications other than poor glycemic control. Histology of biopsies from the skin nodules showed mild foreign-body-like inflammation, prevailing mega-adipocytes (65%), apoptosis, and fibrosis but could not detect any amyloid fibrils. In four cases, intra-nodular fluid was present with an insulin concentration several times higher than in blood. Conclusions: We confirmed LHs to be significantly associated with insulin administration errors, duration of insulin therapy, greater daily doses and duration of insulin administration, and the presence of micro- and macro-vascular DM complications. LH nodules displayed no typical morphological features and were indistinguishable from LIDA nodules with which they shared several histologic similarities, albeit within the frame of a general picture of LIDA inhomogeneity. Further targeted studies are warranted to clarify the remaining doubts. Full article
(This article belongs to the Special Issue Insulin Injection Techniques and Skin Lipodystrophy)
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