AccScience Publishing / GHES / Online First / DOI: 10.36922/ghes.2424
REVIEW

Treatment of insulin-induced skin lipohypertrophy: Costs and sustainability of liposuction and education

Sandro Gentile1,2* Giuseppina Guarino1,2 Ersilia Satta2 Felice Strollo3
Show Less
1 Department of Internal Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy
2 Department of Nefrocenter Research Network, Torre del Greco, Naples, Italy
3 Department of Endocrinology and Diabetes, IRCCS, San Raffaele Pisana, Rome, Italy
Submitted: 13 December 2023 | Accepted: 27 February 2024 | Published: 20 May 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

In the last decade, numerous studies concerning insulin-induced skin lipohypertrophy (LH) were published, mainly addressing epidemiological aspects or presenting case series without placing a focus on LH treatment, among which only a small series (34 cases) has recommended liposuction as LH treatment, albeit not in adherence with the latest American Diabetes Association guidelines. The cost of liposuction, which constitutes a huge financial burden to patients rather than insurance companies or the National Health System (NHS), varies within the range of 1000 – 8000 € with the technique used and the extent and texture of altered skin areas. Primary and secondary prevention through structured educational activities on correct injection techniques with periodic reminders seems to be the only genuinely effective large-scale solution against LH at a much lower, fully NHS-reimbursed cost at 60 € for two annual five-session cycles. However, more research findings, from the angle of esthetic medicine, in support of liposuction as a viable therapeutic solution for LH patients are warranted.

Keywords
Diabetes
Insulin-induced skin lipohypertrophy
Liposuction
Costs
Education
Funding
None.
References

Barak, A., Har-Shai, Y., Ullmann, Y., & Hirshowitz, B. (1996). Insulin-induced lipohypertrophy treated by liposuction. Annals of Plastic Surgery, 37(4):415-417. https://doi.org/10.1097/00000637-199610000-00012

 

Bernstein, G. (1999). Liposuction of the thigh. Clinics in Dermatology, 17(4):849-863, vii. https://doi.org/10.1016/s0733-8635(05)70133-9

 

Blanco, M., Hernández, M.T., Strauss, K.W., & Amaya, M. (2013). Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes and Metabolism Journal, 39(5):445-453. https://doi.org/10.1016/j.diabet.2013.05.006

 

Bodansky, H.J., & Browning, F.S. (1992). Treatment of insulin lipohypertrophy with liposuction. Diabetic Medicine, 9(4):395-396. https://doi.org/10.1111/j.1464-5491.1992.tb01804.x

 

Brun, A., Comparin, J.P., Voulliaume, D., Chekaroua, K., Foyatier, J.L., & Perrot, P. (2007). Lipohypertrophie induite par l’insuline traitée par liposuccion [Insulin-induced lipohypertrophy treated by liposuction]. Annales de Chirurgie Plastique Esthétique, 52(3):218-221. [Article in French] https://doi.org/10.1016/j.anplas.2007.02.003

 

De Mey, A. (1996). Le traitement chirurgical des lipodystrophies [Surgical treatment of lipodystrophies]. Revue Medicale de Bruxelles, 17(4):240-243. [Article in French]

 

Di Bartolo, P., Eckel, R.H., Strollo, F., & Gentile, S. (2021). Hundred-year experience with insulin and lipohypertrophy: An unresolved issue. Diabetes Research and Clinical Practice, 178:108924. https://doi.org/10.1016/j.diabres.2021.108924

 

Dini, M. (2020). Liposuzione e Liposcultura. Available from: https://healthy.thewom.it/terapie/liposuzione [Last accessed on 2020 Jul 15.]

 

ElSayed, N.A., Aleppo, G., Aroda, V.R., Bannuru, R.R., Brown, F.M., & Bruemmer, D. (2023). 9. Pharmacologic approaches to glycemic treatment: Standards of care in diabetes-2023. Diabetes Care, 46(Suppl 1):S140-S157. https://doi.org/10.2337/dc23-S009

 

Frid, A.H., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L.J, et al. (2016). New insulin delivery recommendations. Mayo Clinic Proceedings, 91(9):1231-1255. https://doi.org/10.1016/j.mayocp.2016.06.010

 

Fujikura, J., Fujimoto, M., Yasue, S., Noguchi, M., Masuzaki, H., Hosoda, K., et al. (2005). Insulin-induced lipohypertrophy: Report of a case with histopathology. Endocrine Journal, 52(5):623-618. https://doi.org/10.1507/endocrj.52.623

 

Gandolfi, E., & Thione, A. (2009). A case of insulin lipohypertrophy in a young diabetic female successfully treated by vibroliposuction. Journal of Plastic, Reconstructive and Aesthetic Surgery, 62(12):e601-e603. https://doi.org/10.1016/j.bjps.2008.11.114

 

Gargan, T.J., & Courtiss, E.H. (1984). The risks of suction lipectomy. Their prevention and treatment. Clinics in Plastic Surgery, 11(3):457-463.

 

Gentile, S., Guarino, G., & Strollo, F. (2021b). How to treat improper insulin injection-related lipohypertrophy: A 3-year follow-up of a monster case and an update on treatment. Diabetes Research and Clinical Practice, 171:108534. https://doi.org/10.1016/j.diabres.2020.108534

 

Gentile, S., Guarino, G., & Strollo, F. (2023a). Unexpected evolution of a monster case of insulin-induced skin lipohypertrophy. Diabetes Research and Clinical Practice, 206:110994. https://doi.org/10.1016/j.diabres.2023.110994

 

Gentile, S., Guarino, G., Della Corte, T., Marino, G., Satta, E., Pasquarella, M., et al. (2021a). Role of structured education in reducing lypodistrophy and its metabolic complications in insulin-treated people with type 2 diabetes: A randomized multicenter case-control study. Diabetes Therapy, 12(5):1379-1398. https://doi.org/10.1007/s13300-021-01006-0

 

Gentile, S., Guarino, G., Della Corte, T., Marino, G., Satta, E., Pasquarella, M., et al. (2021c). The durability of an intensive, structured education-based rehabilitation protocol for best insulin injection practice: The ISTERP-2 study. Diabetes Therapy, 12(9):2557-2569. https://doi.org/10.1007/s13300-021-01108-9

 

Gentile, S., Guarino, G., Della Corte, T., Marino, G., Satta, E., Pasquarella, M., et al. (2022a). The economic burden of insulin injection-induced lipohypertrophy. Role of education: The ISTERP-3 study. Advances in Therapy, 39(5):2192-2207. https://doi.org/10.1007/s12325-022-02105-5. Erratum in: 2022, Advances in Therapy.

 

Gentile, S., Guarino, G., Della Corte, T., Marino, G., Satta, E., Pasquarella, M., et al. (2023b). Why do so many people with type 2 diabetes who take insulin have lipohypertrophy? Fate or educational deficiencies? Diabetes Therapy, 14(1):179-191. https://doi.org/10.1007/s13300-022-01341-w

 

Gentile, S., Guarino, G., Della Corte, T.D., Marino, G., Fusco, A., Corigliano, G., et al. (2020). Insulin-induced skin lipohypertrophy in type 2 diabetes: A multicenter regional survey in Southern Italy. Diabetes Therapy, 11(9):2001-2017. https://doi.org/10.1007/s13300-020-00876-0

 

Gentile, S., Guarino, G., Satta, E., Romano, C., & Strollo, F. (2022c). Why 100-Years after the discovery of insulin and the appearance of insulin-induced lipodystrophy: Are we still struggling with this nasty complication? Diabetes Research Open Journal, 8(2):23-29. https://doi.org/10.17140/DROJ-8-156

 

Gentile, S., Satta, E., Guarino, G., Romanom, C., Maffettone, A., Heinke, E., et al. (2022b). A journey through guidelines, consensus, curriculum of educators and clinical practice on insulin-induced skin lipohypertrophy: From the earth to the moon. Medical Research Archives, 10(9). https://doi.org/10.18103/mra.v10i9.3019

 

Gentile, S., Strollo, F., & Nefrocenter Research Study Group. (2018). Cost saving effects of a short-term educational intervention entailing lower hypoglycaemic event rates in people with type 1 diabetes and lipo-hypertrophy. Diabetes Research and Clinical Practice, 143:320-321. https://doi.org/10.1016/j.diabres.2018.07.030

 

Gentile, S., Strollo, F., Della Corte, T., Marino, G., & Guarino, G. (2018b). Skin complications of insulin injections: A case presentation and a possible explanation of hypoglycaemia. Diabetes Research and Clinical Practice, 138:284-287. https://doi.org/10.1016/j.diabres.2018.02.005

 

Gingrass, M.K. (1999). Lipoplasty complications and their prevention. Clinics in Plastic Surgery, 26(3):341-54, vii.

 

Gusenoff, J.A. (2014). Prevention and management of complications in body contouring surgery. Clinics in Plastic Surgery, 41(4):805-18. https://doi.org/10.1016/j.cps.2014.06.006

 

Hardy, K.J., Gill, G.V., & Bryson, J.R. (1993). Severe insulin-induced lipohypertrophy successfully treated by liposuction. Diabetes Care, 16(6):929-930. https://doi.org/10.2337/diacare.16.6.929

 

Hauner, H., & Olbrisch, R.R. (1994). Behandlung einer Typ-I-diabetikerin mit insulin-induzierter lipohypertrophie durch fettgewebssaugung [The treatment of type-1 diabetics with insulin-induced lipohypertrophy by liposuction]. Deutsche Medizinische Wochenschrift, 119(12):414-417. [Article in German] https://doi.org/10.1055/s-2008-1058709

 

Katz, B.E., & Maiwald, D.C. (2005). Power liposuction. Clinics in Dermatology, 23(3):383-91, v. https://doi.org/10.1016/j.det.2005.04.008

 

Mangan, J., Levine, E., & Barrett, K. (2023). Insulin-induced lipohypertrophy treated with liposuction: A review of case reports. Plastic Surgery. https://doi.org/10.1177/22925503231198095

 

Pitman, G.H., & Teimourian, B. (1985). Suction lipectomy: Complications and results by survey. Plastic and Reconstructive Surgery, 76(1):65-72.

 

Samdal, F.A., Amland, P.F., Sandsmark, M., & Birkeland, K.I. (1993). Diabetic lipohypertrophy treated with suction-assisted lipectomy. Journal of Internal Medicine, 234(5):489- 492. https://doi.org/10.1111/j.1365-2796.1993.tb00782.x

 

Scaramuzza, E.A., Ferrari, M., & Zuccotti, G.V. (2015). Elastargene 3C Helps to Improve Glycated Haemoglobin in Children and Adolescents with type 1 Diabetes using Insulin Pump Therapy. Available from: https:// www.easd.org/virtualmeeting/home/html#!resources/ elastargene-3c-helps-to-improve-glycated-hae-moglobin-in-children-and-adolescents-with-type-1-diabetes-us-ing-insulin-pump-therapy--2 [Last accessed on 2023 Dec 28].

Conflict of interest
The authors declare no conflicts of interest.
Share
Back to top
Global Health Economics and Sustainability, Electronic ISSN: 2972-4570 Published by AccScience Publishing