Abstract

Introduction: Lipodystrophy is defined as abnormal thickening of SC tissue at

insulin injection site. It is common, but ignored area. High BMI, high dose of
insulin, failure to rotate injection site, insulin reuse for multiple site are risk
factors. There is scarcity of data on prevalence and associated factors worldwide
and in Ethiopia especially in children. So, to overcome these, further researches are
needed.

Objective: the main objective of the study was to determine the prevalence of and
to assess associated factors in children and adolescents with DM who visited
ACSH, endocrinology clinic between May 1and July 30, 2012 E.C.

Method: This was institution based cross-sectional study done on 122 children and
adolescents who inject insulin for atleast 1 year. Data was collected using
structured questnnaire prospectively by 6 trained residents. LH was diagnosed
using inspection and palpation. Permission was taken from institutional review
board of Mekelle University, CHS, and verbal and written consent taken from care
givers or children. Data was analyzed with SPSS widow version 25.0.

Results: Out of 122 participants, 60 (49.2%) had LH and grade II LH was the
most common type, constituting 81.7%. Thigh was the commonest site for LH.
Duration of injection, dose of insulin, frequency of site rotation and frequency of
needle reuse were associated risk factors (with p- value of <0.05, CI 95%). LH was
also associated with poor glycaemic control (p-value <0.016).

Conclusion: Lipohypertrophy common complication of insulin injection occurring

in 49.2% of cases in this study. Prolonged use of insulin, high dose of insulin,
failure to rotate injection site and pronged use of needle are the risk factors
identified in this study. Lipohypertrophy cause poor glycaemic control.

Key words: Lipohypertrophy, children, adolescents, Mekelle.

 1. Introduction
1.1. Background
1.2. Statement of the problem
1.3. Significance of the study

2. Literature review

3. Objective of the study

4. Methods and materials
5. Plan for dissemination of results.
 6. Results

6.1. Sociodemographic and clinical Characteristics

Of the 122 participants, the male to female ratio was almost equal (1.07: 1)
in which there were 63 males and 59 females. The age distribution was
children (46.7%) and adolescent (53.3%) and mean age is 11.95 (± 4.6 SD)
and median age is 13 years.

All the participants were from Tigray region and 79.5% came from urban
area and 20.5 % are from rural areas.

53.3% of injection providers attended primary school, while 32.8% attend

secondary school, 4.9% had diploma and above. 9% did not start school.

Age of participants constituted 46.7% children and 53.3% adolescents. The

Mean age was 11.95 (± 4.6 SD) and median age is 13 years.

All participants had Type I DM and were injecting mixed NPH and regular
insulin.

65 (53.3%) of participants inject for themselves while 57(46.7%) receive

injection by others (40, by mothers, 16 by fathers and 1 by older sibling.)

Thigh and arm were the most preferred sites of injection (39.3% each) and
none of the participants inject to buttock.

34.4% (42) had underweight and only 2(1.6%) participants were

overweight.
Sociodemographic and clinical characteristics Number %
Age of participant < 5 years 13 10.7%
5 to 12 years 44 36.%
13 years and above 65 53.3%
Sex of participant Male 63 51.6%
Female 59 48.4%
Area of residence Urban 97 79.5%
Rural 25 20.5%
Educational status of Not started 15 12.3%
Patient Kindergarten 8 6.6%
Primary school 77 63.1%
Secondary school 22 18.0%
Collage 0 0.0%
Educational status of Not started 27 22.1%
caregiver Primary School 34 27.9%
Secondary school 40 32.8%
Diploma and above 21 17.2%
Most injections are given Myself 65 53.3%
by Mother 40 32.8%
Father 16 13.1%
Other 1 0.8%
Size of needle used 8 millimeter 117 95.9%
12 millimeter 3 2.5%
Other 2 1.6%
Table 1. Sociodemographic and clinical characteristics
 6.2. Prevalence of lipodystrophy

In this study, lipodystrophy was seen in 60 participants, accounted 49.2% of

cases. Thigh was the commonest site of lipohypertrophy, followed by arm
and abdomen.

Grade II lipohypertrophy was seen in 81.7% of cases. Grade I affected

16.7% while only 1participant had lipoatrophy (1.6%).

49.2% 50.8%
%

Figure 1; prevalence of lipohypertrophy

Figure 2: lipohypertrophy grade and sites