Is lipohypertrophy marely a cosmetic defect? The impact of lipohypertrophy on treatment and lives of patients with diabetes - a literature review
DOI:
https://doi.org/10.12775/QS.2026.55.71080Keywords
Diabetes, complication of diabetes, Lipodystrophy, glycemic control, diabetes distress, hypoglycemiaAbstract
Background: : Lipohipertrophy (LH) is a common complication of diabetes, regardless of its type, in which the tissue exposed to insuline lead to hypertrophy of adipocytes and fibrosis. Despite it looks like only a visual problem, it has many negative consequences, that pose a threat to patients' health, lives, and quality of life.
Aim: In this article we would like to present the multiple dimensions affected by this complication, as well as the potential benefits associated with the treatment of LH.
Methods: A narrative review was conducted using the medical databases PubMed, Google Scholar, and ScienceDirect, with a focus on the impact of insulin-induced LH on the health and daily functioning of patients with diabetes.
Results: The following aspects were analyzed: the impact of LH on glycemic control, risks associated with glycemic variability, long-term complications, quality of life, effects on the management of comorbidities, mental health, and treatment-related costs. Each of these domains was found to be significantly impaired or complicated by the presence of LH. Furthermore, improvements in patient health outcomes were observed in cases where regression of LH lesions was achieved.
Conclusion: The entirety of the reviewed literature indicates that LH constitutes a substantial clinical challenge. Early detection, prevention, and effective management are essential for improving disease control and enhancing the quality of life for patients with diabetes.
References
1. Mangan J, Levine E, Barrett K. Insulin-Induced Lipohypertrophy Treated With Liposuction: A Review of Case Reports. Plast Surg (Oakv). 2025 Feb;33(1):116-122. doi: 10.1177/22925503231198095. Epub 2023 Aug 30. PMID: 39876848; PMCID: PMC11770779. https://doi.org/10.1177/22925503231198095
2. Mader JK, Fornengo R, Hassoun A, Heinemann L, Kulzer B, Monica M, Nguyen T, Sieber J, Renard E, Reznik Y, Ryś P, Stożek-Tutro A, Wilmot EG. Relationship Between Lipohypertrophy, Glycemic Control, and Insulin Dosing: A Systematic Meta-Analysis. Diabetes Technol Ther. 2024 May;26(5):351-362. doi: 10.1089/dia.2023.0491. Epub 2024 Feb 12. PMID: 38215209; PMCID: PMC11058417. https://doi.org/10.1089/dia.2023.0491
3. Ji L, Sun Z, Li Q, et al. Lipohypertrophy in China: Prevalence, Risk Factors, Insulin Consumption, and Clinical Impact. Diabetes Technology & Therapeutics. 2017;19(1):61-67. https://doi.org/10.1089/dia.2016.0334
4. Gupta SS, Gupta KS, Gathe SS, Bamrah P, Gupta SS. Clinical Implications of Lipohypertrophy Among People with Type 1 Diabetes in India. Diabetes Technology & Therapeutics. 2018;20(7):483-491. https://doi.org/10.1089/dia.2018.0074
5. Strollo, F., Guarino, G., Armentano, V., Clemente, G., Martedì, E., Riu, S.D., Gaeta, I., Corigliano, G., Ceriello, A., & Gentile, S. (2016). Unexplained Hypoglycaemia and Large Glycaemic Variability: Skin Lipohypertrophy as a Predictive Sign. http://dx.doi.org/10.17140/DROJ-2-126
6. Boon IS, Saeed MA. Cautionary tale: subdural haematoma following frequent hypoglycaemia from insulin-induced lipohypertrophy. BMJ Case Rep. 2015 Dec 1;2015:bcr2015212855. doi: 10.1136/bcr-2015-212855. PMID: 26628309; PMCID: PMC4680312. https://doi.org/10.1136/bcr-2015-212855
7. Grassi G, Scuntero P, Trepiccioni R, Marubbi F, Strauss K. Optimizing insulin injection technique and its effect on blood glucose control. J Clin Transl Endocrinol. 2014 Jul 23;1(4):145-150. doi: 10.1016/j.jcte.2014.07.006. PMID: 29159095; PMCID: PMC5684966. https://doi.org/10.1016/j.jcte.2014.07.006
8. Lombardo F, Bombaci B, Alibrandi A, Visalli G, Salzano G, Passanisi S. The Impact of Insulin-Induced Lipodystrophy on Glycemic Variability in Pediatric Patients with Type 1 Diabetes. Children (Basel). 2022 Jul 20;9(7):1087. doi: 10.3390/children9071087. PMID: 35884071; PMCID: PMC9316294. https://doi.org/10.3390/children9071087
9. Gentile S, Guarino G, Della Corte T, Marino G, Fusco A, Corigliano G, Colarusso S, Piscopo M, Improta MR, Corigliano M, Martedi E, Oliva D, Russo V, Simonetti R, Satta E, Romano C, Vaia S, Strollo F; AMD-OSDI Study Group on Injection Techniques; Nefrocenter Network and Nyx Start-up Study Group. Lipohypertrophy in Elderly Insulin-Treated Patients With Type 2 Diabetes. Diabetes Ther. 2021 Jan;12(1):107-119. doi: 10.1007/s13300-020-00954-3. Epub 2020 Nov 21. PMID: 33219928; PMCID: PMC7843727. https://doi.org/10.1007/s13300-020-00954-3
10. Gentile S, Strollo F, Satta E, Della Corte T, Romano C, Guarino G; Nefrocenter Research Study Group: Nephrologists, Diabetologists, Nurses. Insulin-Related Lipohypertrophy in Hemodialyzed Diabetic People: a Multicenter Observational Study and a Methodological Approach. Diabetes Ther. 2019 Aug;10(4):1423-1433. doi: 10.1007/s13300-019-0650-2. Epub 2019 Jun 20. PMID: 31222593; PMCID: PMC6612327.
11. Kirac CO, Sirikci V, Findikli HA. The impact of insulin induced lipohypertrophy on carotid intima-media thickness in patients with type 2 diabetes mellitus. Medicine (Baltimore). 2023 Sep 29;102(39):e34696. doi: 10.1097/MD.0000000000034696. PMID: 37773793; PMCID: PMC10545240. https://doi.org/10.1007/s13300-019-0650-2
12. Gentile, Sandro & Satta, Ersilia & Capece, Maurizio & Guarino, Giuseppina & Corte, Teresa & Romano, Carmine & Marino, Giampiero & Pasquarella, Maria & Alfarone, Carmelo & Loiacono, Fabrizio & Lambert, Rossella & Strollo, Felice. (2021). Integrated Approach to Cardio-Vascular Risk in Insulin-Treated People with Diabetes based on the "Heart Project" and on Metabolic Complications Expected from Incorrect Injection Practice-Related Lipohypertrophy. Journal of Diabetes Research Reviews & Reports. 1-8. 10.47363/JDRR/2021(3)126. https://doi.org/10.17140/DROJ-6-148
13. Smith EI, Ciutac A, Smith JC. Lipohypertrophy contributing to severe diabetic ketoacidosis in type 1 diabetes: An increasing problem in the context of the COVID-19 pandemic? Clin Case Rep. 2022 Nov 19;10(11):e6517. doi: 10.1002/ccr3.6517. PMID: 36415718; PMCID: PMC9675868. https://doi.org/10.1002/ccr3.6517
14. Holstein A, Gehrig M, Holstein DJF. Severe Diabetic Ketoacidosis Associated with Abdominal Lipohypertrophy. Dtsch Arztebl Int. 2021 Oct 8;118(40):682. doi: 10.3238/arztebl.m2021.0074. PMID: 34935613; PMCID: PMC8727864. https://doi.org/10.3238/arztebl.m2021.0074
15. Karlin AW, Ly TT, Pyle L, Forlenza GP, Messer L, Wadwa RP, DeSalvo DJ, Payne SL, Hanes S, Clinton P, Maahs DM, Buckingham B. Duration of Infusion Set Survival in Lipohypertrophy Versus Nonlipohypertrophied Tissue in Patients with Type 1 Diabetes. Diabetes Technol Ther. 2016 Jul;18(7):429-35. doi: 10.1089/dia.2015.0432. Epub 2016 May 26. PMID: 27227290; PMCID: PMC4931738. https://doi.org/10.1089/dia.2015.0432
16. DeSalvo DJ, Maahs DM, Messer L, Wadwa RP, Payne S, Ly TT, Buckingham BA. Effect of lipohypertrophy on accuracy of continuous glucose monitoring in patients with type 1 diabetes. Diabetes Care. 2015 Oct;38(10):e166-7. doi: 10.2337/dc15-1267. Epub 2015 Aug 25. PMID: 26307604; PMCID: PMC4876738. https://doi.org/10.2337/dc15-1267
17. AlOzairi A, Irshad M, AlKandari J, AlSaraf H, Al-Ozairi E. Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes. Front Psychiatry. 2024 Mar 22;15:1367876. doi: 10.3389/fpsyt.2024.1367876. PMID: 38585475; PMCID: PMC10995252. https://doi.org/10.3389/fpsyt.2024.1367876
18. Hernar I, Haltbakk J, Broström A. Differences in depression, treatment satisfaction and injection behaviour in adults with type 1 diabetes and different degrees of lipohypertrophy. J Clin Nurs. 2017 Dec;26(23-24):4583-4596. doi: 10.1111/jocn.13801. Epub 2017 May 31. PMID: 28295770. https://doi.org/10.1111/jocn.13801
19. Ciechanowski PS, Katon WJ, Russo JE. Depression and Diabetes: Impact of Depressive Symptoms on Adherence, Function, and Costs. Arch Intern Med. 2000;160(21):3278–3285. doi:10.1001/archinte.160.21.3278 https://doi.org/10.1001/archinte.160.21.3278
20. Gentile S, Guarino G, Della Corte T, Marino G, Satta E, Pasquarella M, Romano C, Alfrone C, Giordano L, Loiacono F, Capece M, Lamberti R, Strollo F; Nefrocenter and Nyx Start-up, AMDOSDI Study Group on Injection Techniques, and ANIAD. The Economic Burden of Insulin Injection-Induced Lipohypertophy. Role of Education: The ISTERP-3 Study. Adv Ther. 2022 May;39(5):2192-2207. doi: 10.1007/s12325-022-02105-5. Epub 2022 Mar 19. Erratum in: Adv Ther. 2022 Jun;39(6):3058. doi: 10.1007/s12325-022-02147-9. PMID: 35306633; PMCID: PMC9056437. https://doi.org/10.1007/s12325-022-02105-5
21. Gentile, Sandro & Guarino, Giuseppina & Satta, Ersilia & Strollo, Felice. (2024). Treatment of insulin-induced skin lipohypertrophy: Costs and sustainability of liposuction and education. Global Health Economics and Sustainability. 2. doi: 10.36922/ghes.2424. https://doi.org/10.36922/ghes.2424
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Alicja Graczyk, Michał Hajt, Natalia Grabowska, Dastin Misiaszek, Anna Wolszczak, Jakub Motor, Weronika Martynowska, Piotr Ciecierski

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 33
Number of citations: 0