Abstract
BACKGROUND: Lipohypertrophy is a common skin complication in people with insulin-treated diabetes. Despite its high prevalence and potential impact on diabetes management and outcomes, published data regarding the risk factors for the development of this complication are contradictory. The study aimed to determine risk factors for lipohypertrophy related to patient characteristics and insulin therapy. METHOD: Medical databases (MEDLINE/PubMed, Embase, CENTRAL) were searched from 1990 to August 21, 2023. All relevant studies describing potential risk factors for lipohypertrophy in people with insulin-treated diabetes (eg, sex, age, body mass index [BMI], type of diabetes, and injection technique) were included. Data enabling calculations of prevalence odds ratios (pOR) and mean differences (MD) with 95% confidence intervals [95% CI] were extracted and pooled in meta-analyses. RESULTS: Fifty-one studies of risk factors for lipohypertrophy were identified. Performed meta-analyses indicate that the strongest contributor to lipohypertrophy was incorrect injection site rotation (pOR = 8.85 [95% CI: 5.10-15.33]), followed by needle reuse (3.20 [1.99-5.13]), duration of insulin therapy >5 years (2.62 [1.70-4.04]) and >2 daily injections per day (2.27 [1.58-3.25]). Those with type 1 diabetes and obese/overweight individuals also had significantly higher odds of developing lipohypertrophy. Sex, age, and insulin device (pen, syringes) were not significant risk factors for lipohypertrophy. CONCLUSIONS: This systematic review with meta-analysis revealed that incorrect injection site rotation and needle reuse are the most substantial factors in developing lipohypertrophy. Notably, both factors are modifiable through patient education, emphasizing the importance of teaching proper injection techniques for better diabetes management.