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Daniel J. Desalvo - One of the best experts on this subject based on the ideXlab platform.

  • duration of infusion set survival in Lipohypertrophy versus nonlipohypertrophied tissue in patients with type 1 diabetes
    Diabetes Technology & Therapeutics, 2016
    Co-Authors: A.w. Karlin, Trang T. Ly, Laura Pyle, Gregory P. Forlenza, Laurel H. Messer, R. Paul Wadwa, Daniel J. Desalvo
    Abstract:

    Abstract Background: Improved insulin infusion set survival and faster insulin action are important issues for pump users and for the development of an artificial pancreas. The current recommendation is to change infusion sets every 3 days. Our objectives were to determine the effect of Lipohypertrophy (LH) on infusion set survival and continuous glucose monitoring glucose levels. Research Design and Methods: In this multicenter crossover trial, we recruited 20 subjects (age 28.1 ± 9.0 years) with type 1 diabetes (duration 17.5 ± 8.8 years) and an area of lipohypertrophied tissue >3 cm. Subjects alternated weekly wearing a Teflon infusion set in an area of either LH or non-LH for 4 weeks. Sets were changed after (a) failure or (b) surviving 7 days of use. Results: The least-squares mean duration of infusion set survival for sets that lasted <7 days in lipohypertrophied tissue was 4.31 days compared with 4.12 days in nonlipohypertrophied tissue (P = 0.71). The average duration of set survival for individua...

Devi Dayal - One of the best experts on this subject based on the ideXlab platform.

  • insulin related Lipohypertrophy lipogenic action or tissue trauma
    Frontiers in Endocrinology, 2018
    Co-Authors: Anjana Barola, Pramil Tiwari, Anil Bhansali, Sandeep Grover, Devi Dayal
    Abstract:

    Lipohypertrophy has been suggested as an outcome of lipogenic action of insulin and/or injection-related tissue trauma. In a cross-sectional study, we evaluated the predictors of Lipohypertrophy in 372 type 1 diabetes patients (mean age 17.1 years) receiving subcutaneous insulin with pen and/or syringes for ≥3 months. On examining injection sites with inspection and palpation technique, 62.1% patients demonstrated Lipohypertrophy. Univariate analysis showed that age, duration of diabetes, socioeconomic status, injection administrator, needle reuse, total daily dose (TDD) of insulin/kg bodyweight, and number of injection sites did not predict Lipohypertrophy (p>0.05). Notably, the mean needle reuse was comparable in patients with or without Lipohypertrophy (8.1 vs 7.2, p=0.534). In multivariate logistic regression, gender, HbA1c, TDD, injection devices, and needle length also lost its significance. Further, injections over smaller area (≤8.5x5.5cm) and non-rotation of sites were found to be strongest independent predictor of Lipohypertrophy (p<.0005 for both) with increased odds of 23.2 (95% CI 9.1-59.2) and 6.3 (95% CI 3.4-11.9) times, respectively. Being underweight was also a significant independent predictor (odds ratio [OR] 13.0 [95% CI 2.2-75.2], p=0.004). Compared to rapid plus long-acting analogues, regular insulin plus long-acting analogues and conventional premixed insulin users had 3.2 (95% CI 1.5-6.8, p=0.003) and 4.6 (95% CI 1.4-15.7, p=0.014) fold higher risk of Lipohypertrophy (mean injection frequency 4.01 vs 4.01 vs 2.09, respectively). Sub-group analysis showed that Lipohypertrophy was 79% less likely in patients with multiple daily injections (≥4) than twice-daily regimen (unadjusted OR 0.21, p<0.0005). Moreover, Lipohypertrophy was reduced to half with bolus doses of rapid-acting insulin analogues than the regular insulin (p=0.003), even though mean injection frequency was comparable (4.01 vs 3.93, p=0.229). This difference was statistically insignificant for basal doses with NPH or long-acting analogues (p=0.069). Therefore, injection area, rotation, BMI, and insulin regimen are the best predictors of Lipohypertrophy and together could correctly identify Lipohypertrophy status in 84.4% patients with excellent discrimination capability (AUC=0.906, p<0.0005). In conclusion, findings of our study suggest that delivering rapidly absorbed insulin analogues over large injection area along with greater split of total daily doses reduce insulin-induced lipogenesis and outplay tissue trauma added through frequent injections.

  • Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma?
    'Frontiers Media SA', 2018
    Co-Authors: Anjana Barola, Pramil Tiwari, Anil Bhansali, Sandeep Grover, Devi Dayal
    Abstract:

    Lipohypertrophy has been suggested as an outcome of lipogenic action of insulin and/or injection-related tissue trauma. In a cross-sectional study, we evaluated the predictors of Lipohypertrophy in 372 type 1 diabetes patients (mean age 17.1 years) receiving subcutaneous insulin with pen and/or syringes for ≥3 months. On examining injection sites with inspection and palpation technique, 62.1% patients demonstrated Lipohypertrophy. Univariate analysis showed that gender, BMI, HbA1c, injection device, rotation, injection area, needle length, insulin regimen, and total daily dose of insulin were associated with Lipohypertrophy (p < 0.05). Notably, the mean needle reuse was comparable in patients with or without Lipohypertrophy (8.1 vs. 7.2, p = 0.534). In multivariate logistic regression, gender, HbA1c, TDD, injection devices, and needle length lost its significance. Further, injections over smaller area (≤8.5 × 5.5 cm) and non-rotation of sites were found to be strongest independent predictor of Lipohypertrophy (p < 0.0005 for both) with increased odds of 23.2 (95% CI 9.1–59.2) and 6.3 (95% CI 3.4–11.9) times, respectively. Being underweight was also a significant independent predictor (odds ratio [OR] 13.0 [95% CI 2.2–75.2], p = 0.004). Compared to rapid plus long-acting analogs, regular insulin plus long-acting analogs and conventional premixed insulin users had 3.2 (95% CI 1.5–6.8, p = 0.003) and 4.6 (95% CI 1.4–15.7, p = 0.014) fold higher risk of Lipohypertrophy (mean injection frequency 4.01 vs. 4.01 vs. 2.09, respectively). Sub-group analysis showed that Lipohypertrophy was 79% less likely in patients with multiple daily injections (≥4) than twice-daily regimen (OR 0.21, p < 0.0005). Moreover, Lipohypertrophy was reduced to half with bolus doses of rapid-acting insulin analogs than regular insulin (p = 0.003), even though mean injection frequency was comparable (4.01 vs. 3.93, p = 0.229). This difference was statistically insignificant for basal doses with NPH or long-acting analogs (p = 0.069). Therefore, injection area, rotation, BMI, and insulin regimen are the best predictors of Lipohypertrophy and together could correctly identify Lipohypertrophy status in 84.4% patients with excellent discrimination capability (AUC = 0.906, p < 0.0005). In conclusion, findings of our study suggest that delivering rapidly absorbed insulin analogs over large injection area along with greater split of total daily doses reduce insulin-induced lipogenesis and outplay tissue trauma added through frequent injections and needle reuse

Marco Scardapane - One of the best experts on this subject based on the ideXlab platform.

  • insulin pump breakdown and infusion set failure in italian children with type 1 diabetes a 1 year prospective observational study with suggestions to minimize clinical impact
    Diabetes Obesity and Metabolism, 2018
    Co-Authors: Ivana Rabbone, Dario Iafusco, Nicola Minuto, Sonia Toni, Fortunato Lombardo, Marco Marigliano, Riccardo Schiaffini, Giulio Maltoni, Anna Paola Frongia, Marco Scardapane
    Abstract:

    AIM: To evaluate the incidence of insulin pump and infusion set failures in a cohort of children and adolescents with type 1 diabetes during a 1-year follow-up. MATERIALS AND METHODS: Insulin pump breakdown and infusion set failures were prospectively registered in a cohort of 1046 children and adolescents from 25 tertiary pediatric diabetes centres (50% male, mean age 12.2 ± 4.1 years), with type 1 diabetes from the age of 6.7 ± 3.6 years, and using an insulin pump from the age of 3.3 ± 2.2 years. RESULTS: An average rate of 4.5 failures/person-year was registered; the incidences (events per person-year) for each failure were 8.4 for hyperglycaemia episodes solved with infusion set change, 7 for bubbles, 2.8 for kinking, 2.4 for bleeding, 2 for set dislodge, 2 for pump blockage, 1.9 for tunnelling, 1.8 for Lipohypertrophy, and 0.3 for infection. At multivariate analysis significant association between HbA1c and Lipohypertrophy (P 11 years) showed a higher frequency of bubbles, hyperglycaemia episodes and Lipohypertrophy in preschoolers; tunnelling and pump blockage were more frequent in adolescents. Aspart was associated with a lower risk of bubbles and hyperglycaemia whereas glulisine was associated with a higher risk of Lipohypertrophy and pump blockage. The usage of oblique cannula was associated with a low risk of all failures except infections. CONCLUSIONS: This prospective 1-year study on a large cohort of Italian children and adolescents with type 1 diabetes using insulin pump therapy showed a low total failure rate, highlighting the importance of continuous education to reduce failures. Lipohypertrophy was the only issue associated with a worsening of metabolic control.

A.w. Karlin - One of the best experts on this subject based on the ideXlab platform.

  • duration of infusion set survival in Lipohypertrophy versus nonlipohypertrophied tissue in patients with type 1 diabetes
    Diabetes Technology & Therapeutics, 2016
    Co-Authors: A.w. Karlin, Trang T. Ly, Laura Pyle, Gregory P. Forlenza, Laurel H. Messer, R. Paul Wadwa, Daniel J. Desalvo
    Abstract:

    Abstract Background: Improved insulin infusion set survival and faster insulin action are important issues for pump users and for the development of an artificial pancreas. The current recommendation is to change infusion sets every 3 days. Our objectives were to determine the effect of Lipohypertrophy (LH) on infusion set survival and continuous glucose monitoring glucose levels. Research Design and Methods: In this multicenter crossover trial, we recruited 20 subjects (age 28.1 ± 9.0 years) with type 1 diabetes (duration 17.5 ± 8.8 years) and an area of lipohypertrophied tissue >3 cm. Subjects alternated weekly wearing a Teflon infusion set in an area of either LH or non-LH for 4 weeks. Sets were changed after (a) failure or (b) surviving 7 days of use. Results: The least-squares mean duration of infusion set survival for sets that lasted <7 days in lipohypertrophied tissue was 4.31 days compared with 4.12 days in nonlipohypertrophied tissue (P = 0.71). The average duration of set survival for individua...

Anjana Barola - One of the best experts on this subject based on the ideXlab platform.

  • insulin related Lipohypertrophy lipogenic action or tissue trauma
    Frontiers in Endocrinology, 2018
    Co-Authors: Anjana Barola, Pramil Tiwari, Anil Bhansali, Sandeep Grover, Devi Dayal
    Abstract:

    Lipohypertrophy has been suggested as an outcome of lipogenic action of insulin and/or injection-related tissue trauma. In a cross-sectional study, we evaluated the predictors of Lipohypertrophy in 372 type 1 diabetes patients (mean age 17.1 years) receiving subcutaneous insulin with pen and/or syringes for ≥3 months. On examining injection sites with inspection and palpation technique, 62.1% patients demonstrated Lipohypertrophy. Univariate analysis showed that age, duration of diabetes, socioeconomic status, injection administrator, needle reuse, total daily dose (TDD) of insulin/kg bodyweight, and number of injection sites did not predict Lipohypertrophy (p>0.05). Notably, the mean needle reuse was comparable in patients with or without Lipohypertrophy (8.1 vs 7.2, p=0.534). In multivariate logistic regression, gender, HbA1c, TDD, injection devices, and needle length also lost its significance. Further, injections over smaller area (≤8.5x5.5cm) and non-rotation of sites were found to be strongest independent predictor of Lipohypertrophy (p<.0005 for both) with increased odds of 23.2 (95% CI 9.1-59.2) and 6.3 (95% CI 3.4-11.9) times, respectively. Being underweight was also a significant independent predictor (odds ratio [OR] 13.0 [95% CI 2.2-75.2], p=0.004). Compared to rapid plus long-acting analogues, regular insulin plus long-acting analogues and conventional premixed insulin users had 3.2 (95% CI 1.5-6.8, p=0.003) and 4.6 (95% CI 1.4-15.7, p=0.014) fold higher risk of Lipohypertrophy (mean injection frequency 4.01 vs 4.01 vs 2.09, respectively). Sub-group analysis showed that Lipohypertrophy was 79% less likely in patients with multiple daily injections (≥4) than twice-daily regimen (unadjusted OR 0.21, p<0.0005). Moreover, Lipohypertrophy was reduced to half with bolus doses of rapid-acting insulin analogues than the regular insulin (p=0.003), even though mean injection frequency was comparable (4.01 vs 3.93, p=0.229). This difference was statistically insignificant for basal doses with NPH or long-acting analogues (p=0.069). Therefore, injection area, rotation, BMI, and insulin regimen are the best predictors of Lipohypertrophy and together could correctly identify Lipohypertrophy status in 84.4% patients with excellent discrimination capability (AUC=0.906, p<0.0005). In conclusion, findings of our study suggest that delivering rapidly absorbed insulin analogues over large injection area along with greater split of total daily doses reduce insulin-induced lipogenesis and outplay tissue trauma added through frequent injections.

  • Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma?
    'Frontiers Media SA', 2018
    Co-Authors: Anjana Barola, Pramil Tiwari, Anil Bhansali, Sandeep Grover, Devi Dayal
    Abstract:

    Lipohypertrophy has been suggested as an outcome of lipogenic action of insulin and/or injection-related tissue trauma. In a cross-sectional study, we evaluated the predictors of Lipohypertrophy in 372 type 1 diabetes patients (mean age 17.1 years) receiving subcutaneous insulin with pen and/or syringes for ≥3 months. On examining injection sites with inspection and palpation technique, 62.1% patients demonstrated Lipohypertrophy. Univariate analysis showed that gender, BMI, HbA1c, injection device, rotation, injection area, needle length, insulin regimen, and total daily dose of insulin were associated with Lipohypertrophy (p < 0.05). Notably, the mean needle reuse was comparable in patients with or without Lipohypertrophy (8.1 vs. 7.2, p = 0.534). In multivariate logistic regression, gender, HbA1c, TDD, injection devices, and needle length lost its significance. Further, injections over smaller area (≤8.5 × 5.5 cm) and non-rotation of sites were found to be strongest independent predictor of Lipohypertrophy (p < 0.0005 for both) with increased odds of 23.2 (95% CI 9.1–59.2) and 6.3 (95% CI 3.4–11.9) times, respectively. Being underweight was also a significant independent predictor (odds ratio [OR] 13.0 [95% CI 2.2–75.2], p = 0.004). Compared to rapid plus long-acting analogs, regular insulin plus long-acting analogs and conventional premixed insulin users had 3.2 (95% CI 1.5–6.8, p = 0.003) and 4.6 (95% CI 1.4–15.7, p = 0.014) fold higher risk of Lipohypertrophy (mean injection frequency 4.01 vs. 4.01 vs. 2.09, respectively). Sub-group analysis showed that Lipohypertrophy was 79% less likely in patients with multiple daily injections (≥4) than twice-daily regimen (OR 0.21, p < 0.0005). Moreover, Lipohypertrophy was reduced to half with bolus doses of rapid-acting insulin analogs than regular insulin (p = 0.003), even though mean injection frequency was comparable (4.01 vs. 3.93, p = 0.229). This difference was statistically insignificant for basal doses with NPH or long-acting analogs (p = 0.069). Therefore, injection area, rotation, BMI, and insulin regimen are the best predictors of Lipohypertrophy and together could correctly identify Lipohypertrophy status in 84.4% patients with excellent discrimination capability (AUC = 0.906, p < 0.0005). In conclusion, findings of our study suggest that delivering rapidly absorbed insulin analogs over large injection area along with greater split of total daily doses reduce insulin-induced lipogenesis and outplay tissue trauma added through frequent injections and needle reuse