胰岛素注射后脂肪增生与脂肪萎缩绪论.pptx

LIPOHYPERTROPHY: the State of the Art Ken Strauss, MD Global Medical Director, BD Director Safety in Medicine, European Medical Association Lypohypertrophy Picture courtesy of Nurse Ruth Gaspar, Madrid, Spain Seven landmark studies Frequency Causes Histopathology Absorption Glucose control Insulin reductions Cost savings LH is common 15.9% (Kashi et al 2008) 27.1% (Raile et al. 2001) 34.5% (Partanen, Rissanen 2000) 48.0% (Kordonuri et al 2002) 57.0% (Teft 2002) Have you ever noticed swelling of fatty tissue or small bumps at your injection sites? 48% said yes* *2009 ITQ Survey 44,6 USA 44,6 RUSSIA 45,6 NETHERLANDS 54,2 BELGIUM 50,4 FRANCE 51,7 SPAIN 44,6 ITALIA 73,3 SWITZERLAND 54,2 UK IRELAND 56,6 DENMARK 60,0 SWEDEN 52,2 GERMANY 31,1 CHINA 33,1 TURKEY 30,0 PORTUGAL 88,0 FINLAND De Coninck C, et al. Results and analysis of the 2008-2009 Insulin Injection Technique Questionnaire survey. J Diabetes. 2010 Sep;2(3):168-79. What is your experience? Seven landmark studies Frequency Causes Histopathology Absorption Glucose control Insulin reductions Cost savings Results: Frequency lipohypertrophy : 48.8% Three independent risk factors : Using insulin for long time (p=0.001), Giving injection in same place (p=0.004), Reusing the same needle (p=0.004). . Could there be other causes? Seven landmark studies Frequency Causes Histopathology Absorption Glucose control Insulin reductions Cost savings How is insulin absorbed in lipohypertrophy? Seven landmark studies Frequency Causes Histopathology Absorption Glucose control Insulin reductions Cost savings Diabetes Care 2005; 28:2025-2027 Continuous glucose monitoring system Shows the patient not only concrete moments, but provides a global vision of the situation Medtronic ? Injection in lipohypertropy Average= 220 mg/dl; SD = 66 Insulin = 33 U/day Injection in healthy area Average= 155 mg/dl; SD = 47 Insulin = 28 U/day Do you think of lipohypertrophy in patients with unsta