Page 21 - GHES-2-2

Global Health Econ Sustain

REVIEW ARTICLE
Treatment of insulin-induced skin

lipohypertrophy: Costs and sustainability of
liposuction and education

2
1,2
1,2
Sandro Gentile * , Giuseppina Guarino , Ersilia Satta , and Felice Strollo 3
1 Department of Internal Medicine, Campania University “Luigi Vanvitelli”, Naples, Italy
2 Department of Nefrocenter Research Network, Torre del Greco, Naples, Italy
3 Department of Endocrinology and Diabetes, IRCCS, San Raffaele Pisana, Rome, Italy

Abstract

In the last decade, numerous studies concerning insulin-induced skin lipohypertrophy
(LH) were published, mainly addressing epidemiological aspects or presenting case
series without placing a focus on LH treatment, among which only a small series
(34 cases) has recommended liposuction as LH treatment, albeit not in adherence with
the latest American Diabetes Association guidelines. The cost of liposuction, which
constitutes a huge financial burden to patients rather than insurance companies or
the National Health System (NHS), varies within the range of 1000 – 8000 € with the
technique used and the extent and texture of altered skin areas. Primary and secondary
Academic editor: prevention through structured educational activities on correct injection techniques
Mihajlo Jakovljevic M.D. Ph.D. MAE with periodic reminders seems to be the only genuinely effective large-scale solution
against LH at a much lower, fully NHS-reimbursed cost at 60 € for two annual five-
*Corresponding author:
Sandro Gentile session cycles. However, more research findings, from the angle of esthetic medicine,
(nefrocenter2018@legalmail.it) in support of liposuction as a viable therapeutic solution for LH patients are warranted.
Citation: Gentile, S., Guarino, G.,
Satta, E., & Strollo F. (2024).
Treatment of insulin-induced Keywords: Diabetes; Insulin-induced skin lipohypertrophy; Liposuction; Costs; Education
skin lipohypertrophy: Costs and
sustainability of liposuction and
education. Global Health Econ
Sustain, 2(2): 2424.
https://doi.org/10.36922/ghes.2424 1. Introduction
Received: December 13, 2023 Insulin-induced skin lipodystrophies (I-LD) have been well-documented since the
inception of insulin therapy nearly 100 years ago (Gentile et al., 2022a; Di Bartolo et al.,
Accepted: February 27, 2024
2021). In the early era when insulin was first introduced, hypo-atrophic type, that is,
Published Online: May 20, 2024 lipohypotrophy, was the most prominent variant of I-LD, which is mainly resulted
Copyright: © 2024 Author(s). from immuno-allergic phenomena caused by impurities and allergenic molecules from
This is an Open-Access article animal pancreas obtained using the less refined extraction techniques (Blanco et al.,
distributed under the terms of the
Creative Commons Attribution 2013; Gentile et al., 2020). Subsequently, with the advent of recombinant DNA-based
License, permitting distribution, human insulins and hormone analogs, lipohypertrophy (LH) became the prevalent form
and reproduction in any medium, of I-LD, primarily due to the uncontrolled anabolic action of insulin, non-adherence to
provided the original work is
properly cited. the proper injection site rotation, and needle reuse that causes repeated microtraumas to
certain skin areas (Blanco et al., 2013; Di Bartolo et al., 2021; Gentile et al., 2020; Gentile
Publisher’s Note: AccScience
Publishing remains neutral with et al., 2022a; Gentile et al., 2023a) (Figure 1).
regard to jurisdictional claims in
published maps and institutional Numerous papers concerning insulin-induced skin LH were published in the
affiliations. last decade, mainly addressing epidemiological aspects or presenting case series

Volume 2 Issue 2 (2024) 1 https://doi.org/10.36922/ghes.2424