Page 23 - GHES-2-2

Global Health Econ Sustain Treatment and costs of skin lipohypertrophy

Table 1. General characteristics of subjects undergoing liposuction for insulin‑induced lipohypertrophy treatment
T1DM/T2DM Age (years) Sex (male/female) Primary General Local MVRS (mL) TVRP (mL) APOFT
(count) indication anesthesia anesthesia (months)
34/4 38 (21–52) 24/14 Cosmetic 100% 55.6% 44.4% 200 (25–600) 910 (200–2900) 5.3 (2–10)
Notes: Ranges are given in parentheses. Secondary indications include pain (16.7%), injection troubles (16.7%), and poor glycemic control (11.1%).
Abbreviations: T1DM: Type 1 diabetes mellitus; T2DM: Type 2 diabetes mellitus; MVRS: Median volume of adipose tissue removed per site; TVRP:
Total volume of adipose tissue removed per patient; APOFT: Average postoperative follow-up time.

enlargement in original LHs (Fujikura et al., 2005; Mangan place—and the signs of hypoglycemia had ceased to appear
et al., 2023), and we also observed the same finding in our ever since (Blanco et al., 2013). The skin abnormalities were
patient sample, as well as fibrosis on biopsies performed on hardly resolved in 3 years, but no skin alterations occurred
our patients’ lesions (unpublished data). after employing insulin injection avoidance (Figure 2).
The costs of liposuction, which vary with the site, size, No dataset was generated for this study, as we only
and number of treated areas, range from 1000 to 8000 €/area present previously published data in this paper. Statistical
and depend not only on the extent and texture of the mass evaluations had been conducted by studies cited in this
to be removed but also on cardiovascular and metabolic paper.
comorbidities, eventually requiring multidisciplinary
collaborations for treatment. Usually, the in-hospital 4. Discussion
intervention lasts only a few hours and necessitates As demonstrated by our previous study and other reports,
monitoring of edema and stress after the operation. intensive education on correct injection techniques is
However, sometimes, this type of intervention and the essential to guaranteeing the recovery of regular skin
related anesthetics strategy can significantly increase features, severe sudden hypoglycemic episodes, and large
the duration of hospitalization (Fujikura et al., 2005). glycemic fluctuations, but the time needed for aesthetic as
Unfortunately, such procedures, being interpreted as part well as functional recovery of skin affected by severe LH is
of an esthetic medicine intervention rather than therapy, exceptionally long (Gentile et al., 2023a; Gusenoff, 2014;
are not reimbursed by private insurance companies and Katz & Maiwald, 2005).
the Italian National Health System (NHS).
Although long-term avoidance of insulin injection into 4.1. Time required for LH resolution
LH nodules is the safest method to shrink and eradicate Presently, there are no accurate findings regarding the
LH lesions (Gusenoff, 2014), disappointing outcomes time required for instant LH disappearance. However, it
would still occur after 12 – 18 months of insulin injection is known that a larger lesion requires longer resorption
avoidance (Katz & Maiwald, 2005). On the contrary, time (Gusenoff, 2014). Therefore, patients suffering
ISTERP-3 study (Gentile et al., 2022a) on social and from concurrent diabetes and LH, especially female,
economic effects of intensive therapeutic education on LH are averse to spend a long time for the resolution of LH
prevention clearly showed that education-based approach skin blemishes, if a fast esthetic solution is available.
can reduce operation costs by 76.9% after 6 months and Nonetheless, our previous findings concerning a case
by 83.1% after 12 months in the intensive education IG, with two large, umbilicated LH lesions show that the time
as compared to almost null changes (even decreasing needed for esthetic as well as functional recovery of skin
over time) in the CG who had been educated only once, affected by severe LH is exceptionally long (Gentile et al.,
12 months before the previous observation (Table 2). 2023a; Gusenoff, 2014; Katz & Maiwald, 2005).
In addition, our review also encompasses the case of a 4.2. Liposuction
patient with two very large LHs with a hyperpigmented,
umbilicated central area and a pseudo-cystic insulin The utilization rate of liposuction in the general population
reservoir having an insulin concentration 13 times higher of LH-affected subjects has been underestimated since this
than that in plasma. Such a lesion caused a severe risk technique is prevalently performed in private institutions
of massive, uncontrolled hormone release and implied where revenue concerns vastly outweigh the need to
the potential consequences of a sudden, unexpected publish scientific results. In fact, a series of informative
hypoglycemia. In the absence of any further intra-nodular articles grouped under the “LH therapy” or “insulin-
injection for 3 years, the swollen and centrally umbilicated, induced skin blemishes” were posted by private cosmetic
hyper-pigmentated area in this patient had almost surgery-devoted centers to advertise liposuction as a
disappeared—despite disfiguring scars remaining in practical, fast, and safe method to address the problem.

Volume 2 Issue 2 (2024) 3 https://doi.org/10.36922/ghes.2424