PREVALENCE OF INSULIN-INDUCED LIPODYSTROPHY AND ITS RELATIONSHIP WITH GLYCEMIC CONTROL AMONG ADULT PATIENTS WITH DIABETES AT GONDAR UNIVERSITY SPECIALIZED HOSPITAL, GONDAR, NORTH WEST ETHIOPIA, 2024

Abstract

Background Lipodystrophies are disorders with abnormal fat distribution, either genetic or acquired, and can be generalized or localized. Insulin-induced lipodystrophy, a type of acquired partial lipodystrophy, includes two subtypes: lipohypertrophy and lipoatrophy. However, data on the prevalence of insulin-induced lipodystrophy among adult diabetic patients in Ethiopia is limited. Objective: This study aimed to assess the prevalence and associated factors of insulin-induced lipodystrophy among diabetes mellitus patients receiving insulin therapy at Gondar University Specialized Referral Hospital, Ethiopia Method: An Institution-based cross-sectional study was carried out on diabetic patients who inject insulin for minimum of one year. Data was gathered using Kobo Collect and subsequently analyzed with the Statistical Package for the Social Sciences (SPSS) version 26. Both bi-variable and multivariable binary logistic regression analyses were utilized to determine factors associated with the outcome variable. 95% confidence interval and p-value ≤ 0.05 used to determine associated factors. RESULTS: A total of 381 diabetic patients were studied, 56% of whom were diagnosed with Type 2 Diabetes Mellitus (T2DM). The overall prevalence of lipohypertrophy (LH) was found to be 46% (95% CI: 41.22%-51.24%), with the thigh being the most common site. Several factors were significantly associated with LH, including a duration of insulin use greater than 6 years: 6 10 years (AOR=1.97, 95% CI: 1.02, 3.90), 11-15 years (AOR=4.05, 95% CI: 2.00, 8.25), and ≥16 years (AOR=5.55, 95% CI: 2.62, 11.74). A daily insulin dose greater than 0.6 IU/kg (AOR=1.97, 95% CI: 1.22, 3.22) and higher frequency of insulin injections, particularly twice daily (AOR=25.60, 95% CI: 3.28, 200). Additionally, patients who spaced their insulin injections two or more fingers apart had a lower risk of developing LH (AOR=0.31, 95% CI: 0.15, 0.63), compared to those who did not measure injection sites. Patients with LH were almost three times more likely to experience unexplained hypoglycemia and had a twofold higher hemoglobin A1c (HbA1c) level (>8) compared to those without LH. Lipoatrophy (LA) was rare, affecting only 2% of patients, with all cases occurring in areas adjacent to palpable LH. CONCLUSIONS: A 46% prevalence rate of lipohypertrophy in this study highlights the importance of adopting a preventive strategy. The presence of lipohypertrophy was significantly associated with unexplained hypoglycemia and poor glycemic control. It is crucial to identify this condition through regular inspection and palpation of insulin injection sites, as well as to educate patients on strategies to prevent the onset of lipodystrophy