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Lipoatrophy in children, adolescents and adults with insulin pump treatment: Is there a beneficial effect of insulin glulisine?
Author(s) -
Kordonouri Olga,
Biester Torben,
Weidemann Jürgen,
Ott Hagen,
Remus Kerstin,
Grothaus Julia,
Pisarek Nicole,
Hartmann Reinhard,
Adolph Kerstin,
Lange Karin,
Danne Thomas
Publication year - 2020
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.13094
Subject(s) - medicine , lipoatrophy , insulin pump , insulin , randomization , randomized controlled trial , clinical endpoint , diabetes mellitus , magnetic resonance imaging , type 1 diabetes , gastroenterology , surgery , endocrinology , radiology , family medicine , human immunodeficiency virus (hiv) , viral load , antiretroviral therapy
Aim To investigate whether zinc‐free insulin is an effective treatment option for lipoatrophy. Methods Controlled, randomized, open‐label parallel study in young people with type 1 diabetes, pump treatment and lipoatrophy at injection sites. Participants underwent dermatological examination and evaluation of affected areas using ultrasound and magnetic resonance imaging (MRI). After randomization, half of themswitched to insulin glulisine (intervention group) for 6 months. The control group continued their treatment with zinc‐containing insulin and switched to insulin glulisine 6 months later. Both groups were followed‐up until month 12. Primary endpoint was the increase of the relative thickness of the subcutaneous fat layer of the most atrophic site at 6 months as documented by MRI. Results Fourteen participants were included into the study. While relative thickness of subcutaneous fat tissue was comparable between intervention (−60% [−98.8 ‐ −17.6], n = 7) and control group (−50% [−72.7 ‐ −1.0], P = .511; median (range), n = 7)at baseline, it improved in the intervention (−14.3% [−85.7‐83.3] vs ‐31.3% (−66.7‐0), P = .031), but not in the control group ( P = .125) after 6 months. At 12 months, relative fat thickness ( P = .003), number ( P = .015) and size of most atrophic sites ( P = .001) were improved in the intervention group. Number ( P = .018) and size of most atrophic sites ( P = .008) were also reduced in the control group between 6 and 12 months. Conclusions Although the present pilot study is based on a small sample, the data give first hint that the use of the zinc‐free insulin glulisine may be beneficial in people with diabetes, pump and lipoatrophy.