Lipohypertrophy is just one of those big words for bad side effects of diabetes which no one ever warns you about.
Basically, it’s a state common in those of us who inject ourselves — an accumulation of fat and scar tissue under the skin causing lumps which aren’t only unsightly, but interfere with insulin absorption, making it even harder for us to manage our ailment. Ugh!
Honestly, we never believed we would have anything great to say about lipohypertrophy… before hearing about a current research at Stanford University with surprising outcomes:
Researchers found that (get this!) CGM detectors set on spots with lipohypertrophy showed equivalent or superior accuracy across all glucose ranges to the detectors put on more “virgin” skin.
This was my reaction, too, so I took a while to ask a few questions of Daniel de Salvo, a post-doctoral fellow in pediatric endocrinology at Stanford and first author on the abstract presented at the current ATTD seminar. (The complete manuscript on this study report is in the works, and the principal investigator and senior author is Dr. Bruce Buckingham.)
Be aware that Daniel isn’t merely a researcher, however, a longtime form 1 himself, that can be found on Twitter as @MDwithT1D.
DM) Is this the first research of its type?
DDS) Yes, this is the first study assessing the effect of lipohypertrophy on CGM detector functionality.
When and where did the research take place?
The analysis took place at Stanford University and University of Colorado, Denver. Registration started in November 2013 and also the last study visit occurred in December 2014. The research lasted for four weeks with weekly research visits happening at the Clinical & Translational Research Unit (CTRU), but otherwise patients were going about their daily lives at home, school, and function between visits.
Your abstract states that “accuracy evaluation was conducted on matched detector glucose pairs in lipohypertrophied and normal tissue” Can you describe this investigation method in laymen’s terms?
Sure! Two detectors were put on each subject: 1 in tissue and you in a place of lipohypertrophy. CGM readings were available every 5 minutes. Precision analysis was conducted by comparing the detector reading in normal tissue to the detector reading in lipohypertrophy at each time point (i.e. each 5 minutes). A low coefficient of variation (PCV) or precision total relative difference (PARD) suggests a smaller gap between the 2 groups (i.e. enhanced precision). The PCV and PARD also well to printed reports of precision evaluation of two detectors in ordinary tissue. This also indicates that the detector in lipohypertrophy was not far off from detectors in normal tissue.
What was the theory? That lipohypertrophy would negatively influence both pump sites and CGM sites?
We know from previous studies which lipohypertrophy can interfere with insulin absorption, adversely affecting blood glucose. We hypothesized lipohypertrophy could have a negative effect on CGM sensor functionality too.
Was the research team surprised by the outcomes?
Yes, we were very surprised by the results! Sensors in lipohypertrophy showed equivalent or superior accuracy across all glucose ranges. This was definitely a pleasant surprise.
What effect might these consequences have on the bigger picture of diabetes care?
The evidence is persuasive that sensor-augmented treatment can enhance diabetes care, and closed-loop systems (requiring pump and CGM) will hopefully become commercially available from the foreseeable future. Finding areas for sensor and pump can be challenging, especially for those who have had diabetes for a long time. As clinicians, we are constantly telling patients to Prevent lipohypertrophy, which can be very difficult for some. We can say: ‘Prevent areas of lipohypertrophy for insulin delivery, however, you can use that preferred site for detectors’
How can these research results be disseminated and used? I.e. will CGM manufacturers include this information in CDE training? Or might they pursue further research?
CGM manufacturers including Dexcom and Medtronic were very curious about these outcomes. It remains to be seen how CGM makers will use this information. It is unlikely they’ll use this information in CDE training before longterm data can be obtained.
What will you personally want to say to the type 1 diabetes community what you learned in this research?
The message is simple: “You should avoid areas of lipohypertrophy for insulin delivery, but it may be OK to use them for CGM detector sites.” Those of us with T1D have restricted real estate for injections/pumps/sensors, therefore this opens up some space! Additional work is needed to assess the potential dangers of using sensors at lipo sites over long Intervals.
Thank you Daniel & the Stanford team! It sure is great to get some fantastic information about the bad things once in a while!
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content isn’t medically reviewed and does not adhere to Healthline’s editorial guidelines. For more information about Healthline’s venture with Diabetes Mine, please click here.
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