A Journey Through Guidelines, Consensus, Curriculum of Educators and Clinical Practice on Insulin-Induced Skin Lipohypertrophy: From the Earth to the Moon

Abstract

This minireview wants to draw the readers' attention to a neglected complication of insulin therapy, i.e., lipohypertrophy due to injection errors. The considerable diffusion of lipohypertrophy represents evidence of a lack of education and monitoring. This phenomenon occurs despite international recommendations on correct injection techniques in the latest American Diabetes Association Standards of Medical Care in Diabetes edition. There are no precise indications in the literature for well-organized courses for educators like those promoted by the International Diabetes Federation. The damage caused by LH, such as poor glycemic control, significant blood sugar variability, and unexpected hypoglycemic events, represents a high risk for acute and chronic complications of diabetes and an increase in health and social costs. Unfortunately, as reported by the WHO, health costs tend to increase spontaneously over time and have been increasing recently with the COVID-19 pandemic, which has also enormously contributed to new cases of diabetes. For all this, a call to action is required for errors in insulin injection techniques across the board, involving university programs, specialization programs, joint efforts of all scientific endocrinology-related societies, manufacturers of insulin and injection devices, and Ministries of health.