MODERN VIEW ON DIAGNOSTICS AND PRE VENTION OF LIPODYSTROPHIES IN PATIENTS WITH DIABETES MELLITUS

Authors

  • Chumak S. O. SI «Institute for Children and Adolescents Health Care of the NAMS of Ukraine», Kharkiv, Ukraine

DOI:

https://doi.org/10.21856/j-PEP.2020.2.16

Keywords:

diabetes mellitus, glycemic variability, lipodystrophy, ultrasound

Abstract

The article discusses the modern possibilities of improving the diagnosis, prevention and timely treatment
of lipodystrophy in patients with type 1 diabetes and their effect on the compensation of type 1 diabetes in
children. A review of international studies on lipodystrophy (LD) and their own results are presented. In 150 patients with type 1 diabetes at the age of 6–17 years, equally distributed by compensation level, diabetes and
gender experience, LD was determined visually, by palpation, as well as by ultrasound of subcutaneous fat
(TFA) 265 insulin injection sites. Blood circulation was studied in the affected areas of the pancreas. Glycemic
control indices were calculated taking into account the coefficient of variability (CV) in patients with and without LD. According to the results of a clinical examination, LDs were found in 38% of patients, according to
ultrasound tests of pancreatic cancer 265 insulin injection sites — in 72% of patients. Most often (61%), LDs
were found in the paraumbilical region, in shape: diffuse — 56% focal — 24%, mixed — 15%, in the thigh region — muscular (3%) and atrophic (2%). LD prevailed (in 84%) among patients with high risk glycemic control
(average level of glycosylated hemoglobin — НВА1с = 10.42%). Among children with optimal glycemic control
(HBA1c = 7.8%), 85% had no lipodystrophy (p < 0.001). Accordingly, high variability (CV > 36%) was determined in 62% of patients with LD, and only in 28% of patients without LD (p < 0.05). Thus, the relationship
between the presence of LD and glycemic parameters in children and adolescents with type 1 diabetes mellitus,
which affect the variability of glycemia and the formation of complications of diabetes, is determined.
The use of ultrasound once every 6 months is necessary to diagnose the state of subcutaneous fat at the
injection sites of insulin in children with type 1 diabetes. Prevention of LD is possible by using short needles
(4 mm) and following the injection technique.

References

American Association of Diabetes Educators. Medical Diabetes Care 2011; 18(3): 745-749.

ISРAD Clinical Practice Consensus Guidelines Compendium. Pediatric Diabetes 2015; 12: 89-109.

Rekomendacii IDF, available at: https://xn-80aa4apjd3a.com/1-tip/tehnika-inektsiy-insulina-rekomendatsiiidf-10318543.html.

Frid A, Hirsch L, Gaspar R, et al. Diabetes Metab 2010; 36(2): 3-18. doi: http://doi.org/10.1016/S1262-3636(10)70002-1.

Famulla S, Hцvelmann U, Fischer A, et al. Diabetes Care 2016; 39(9): 1486-1492. doi: http://doi.org/10.2337/dc16-0610.

Chumak S, Budreiko O. 55th Annual Meeting of the ESPE. Abstract book, Paris, 2016: 199-200.

Perciun R. Medical Ultrasonography 2012; 14(1): 60-63.

Blanco M, Hernandez M, Strauss K, Amaya M. Diabetes Metab 2013; 39(5): 445-453. doi: http://doi.org/10.1016 // j.diabet, 2013.05.006.

Goupta J, Felner E. Diab Technol Ther 2011; 13(4): 451-456. doi: http://doi.org/10.1089/dia.2010.0204

Chumak SA. Probl Endokryn Patologii' 2017; 1: 16-32. doi: http://doi.org/10.21856/j-PEP.2017.1.04.

Lo Presti D, Ingegnosi C, Strauss K. Pediatric Diabetes 2012; 5. doi: http://doi.org/10.1111/j.1399-5448.2012.00865.x

Chumak SO, Budrejko OA. Inform. bjul.: dodatok. do «Zhurn NAMN» 2016; 41: 143-144.

Pettis RJ, Ginsberg B, Hirsh L, et al. Diab Technol Ther 2011; 13(4): 435-442. doi: http://doi.org/10.1089/dia.2010.0184.

Polak M, Beregszaszi M, Belarbi N. Diabetes Care 2006; 19(12): 1434-1436. doi: http://doi.org/10.2337/diacare.19.12.1434.

Selkow NM, Pietrosimone BG. J Athletic Train 2011; 46(1): 50-54. doi: http://doi.org/10.4085/1062-6050-46.1.50.

Gibney MA, Arce CH, Byron KJ, Hirsch LJ. Curr Med Res Opin 2010; 26(6): 1519-1530. doi: http://doi.org/10.1185/03007995. 2010.481203.

Volkova NI, et al. XXXI World congress of internal medicine. Final program 2012: 102.

Service FJ. Diabetes 2013; 62: 1398-1404. doi: http://doi.org/10. 2337/ db12-1396.

Chumak SA. Pjat' navykov dlja zhizni s diabetom, Kiev, 2018: 121 p.

Lazarev M, Mahotin A, Klimontov V. Ul'trazvukovaja harakteristika krovosnabzhenija uchastkov lipogipertrofii, inducirovannoj insulinom, u bol'nyh saharnym diabetom, Novosibirsk, 2019: 152 p.

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Published

2021-06-30

How to Cite

Chumak S. О. . (2021). MODERN VIEW ON DIAGNOSTICS AND PRE VENTION OF LIPODYSTROPHIES IN PATIENTS WITH DIABETES MELLITUS. Problems of Endocrine Pathology, 72(2), 128-141. https://doi.org/10.21856/j-PEP.2020.2.16