Authors (including presenting author) :
Chan WS, Loo KM, Ozaki R
Affiliation :
Diabetes and Endocrine Centre, Prince of Wales Hospital
Introduction :
Lipohypertrophy (LH) is a common complication affecting nearly 50% of insulin users. According to meta-analyses, the global prevalence of lipohypertrophy (LH) is as high as 41.8% (95% CI: 35.9%–47.6%). Patients with lipohypertrophy are more likely to experience unexplained hypoglycemia, glycemic variability, higher HbA1c levels and have higher daily insulin requirements. However, many patients may not be aware of the importance of the systematic rotation of insulin injection sites. Furthermore, the busy nature of medical clinics with long interval follow-up may lead to these issues going unnoticed. To facilitate early detection and management of LH, insulin injection techniques and insulin injection sites are assessed during diabetes nurse clinic, according to local and international guidelines.
Objectives :
1. Evaluate the change in total daily dose (TDD) of insulin requirement before and after nursing intervention, of patients with LH
2. Assess the impact nursing intervention on the clinical outcome of LH-affected individuals, including changes in A1c and BMI.
Methodology :
Study Period: 1 June 2024 – 31 December 2024
A cumulative total of 199 interview sessions were conducted with diabetic patients who utilized insulin therapy, observed at a specialized Advanced Practice Nurse (APN) clinic at Prince of Wales Hospital for diabetes education and management. Some patients participated in multiple interviews throughout this period. During this time, 40 patients were found to have lipohypertrophy (LH) based on diagnostic techniques such as visual inspection and manual palpation. The nurse promptly provides intensive interventions as per FIT guidelines. To reduce the risk of hypoglycemia after switching to healthy injection sites, insulin dosages were adjusted, and close blood glucose monitoring was implemented through frequent consultations, phone follow-ups, and, when clinically indicated, the use of continuous glucose monitoring devices.
Result & Outcome :
Results:
Significant changes were noted in TDD, BMI, and A1c levels subsequent to this intervention. Mean A1c decreased by 0.62% (95% CI 0.28-0.96, p < 0.001), BMI difference (pre-post) -0.23 kg/m2 (95% CI 0.026-0.426kg/m2) and mean TDD decreased by 23.05 units per patient (95% CI: 17.15-28.95, p< 0.001), equivalent to a 34.33% (95% CI: 29.3-39.37, p< 0.001) reduction in insulin requirement. The average annual insulin cost decreased by HKD 1,879.02 per patient.
Conclusions:
Not only were there positive changes towards improved health outcomes, but there were also cost savings in diabetes care, including reduced total daily insulin requirement and treatment of complications. Based on the Hospital Authority Diabetes Mellitus Care Report 2019-2020 and global prevalence rates, we project that 22,511 to 29,776 insulin-treated patients may develop lipohypertrophy among a cohort of 62,300 individuals. Therefore, the potential total annual savings for these patients is approximately HKD 48,966,354, attributed to the reduced costs from the decreased total insulin dosage, with a range between HKD 42,148,938 and HKD 56,095,731.
