Authors (including presenting author) :
Hui KMC (1), Hung SCV (1), Chow MF (1), Ng HF (1), Lee YM (1), Wong YK (2), Tsang V (2) Kwok KYS (2), Ho YYA (1)
Affiliation :
(1) Department of Medicine and Geriatrics, Tuen Mun Hospital
(2) Department of Radiology, Tuen Mun Hospital
Introduction :
Lipohypertrophy (LH) is the thickening of subcutaneous adipose tissue caused by incorrect injection site, limited injection area, prolonged insulin use, and needle reuse. Traditionally, LH detection has relied on inspection and palpation. The use of Point-of-Care Ultrasound (POCUS) allows nurses to detect LH with greater detail, especially subclinical LH.
Objectives :
1. To assess locally trained nurses' ability in POCUS for detecting insulin-induced LH
2. To measure the effect of intervention by analyzing HbA1c levels, Total Daily Dose (TDD) of insulin and LH size.
Methodology :
The study was performed on type 1 or type 2 diabetes patients, with multiple daily injection over one year and HbA1c > 7%. Five nurses received training on POCUS before the study. Twenty patients received POCUS by five nurses independently, followed by a radiologist blinded to nurses’ examinations. Results were validated against the radiologist's findings using the Cohen k statistic. Patient education on LH risk factors and proper injection techniques was also provided on the same day. A paired t-test was used to analyze significant differences following the interventions.
Result & Outcome :
From March 2024 to June 2024, twenty patients were recruited but eighteen completed the study. Two nurses achieved the highest agreement (91.3%) with the radiologist in detecting LH, with a Cohen k-value of 0.775. Using POCUS to evaluate LH size and reviewing HbA1c and TDD of insulin six months later, the results showed significant reduction in LH size from 4.34 cm² ± 2.52 to 1.97 cm² ± 1.43 (p < 0.001). However, there is no significant change in HbA1c levels (Mean 9.72 ± SD 1.91) at baseline and (Mean 9.28 ± 2.01) at post-intervention, (p = 0.10) and TDD of insulin (Mean 41.89 ± 17.17) at baseline and (Mean 40.06 ± 17.78), (p = 0.33) at post-intervention.
Conclusion:
This study marks a new milestone for diabetes nurses in using POCUS to evaluate LH, particularly in patients with subclinical LH. Despite no significant changes in HbA1c and TDD of insulin, the significant reduction in LH size indicates that incorporating POCUS could lead to better management and improvement in patient care outcomes.