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Global Health Econ Sustain Treatment and costs of skin lipohypertrophy

Soothing creams and massages have been
recommended online as treatment options, but their
efficacy lacks scientific evidence. It is important to
note that thermal and mechanical effects of massaging
can result in even more deleterious impacts due to
the untimely release of LH-stored insulin into the
bloodstream and the consequent severe hypoglycemic
events, as observed in a young woman affected by Type 1
diabetes (Gentle et al., 2018b; Gentile et al., 2021a;
Gentile et al., 2023b).
Thus, at present, prophylactic strategy is the only
genuinely effective remedy against LH, which can be
implemented through intensive, structured education
with periodic reminders on correct injection techniques
(Frid et al., 2016). This tactic involves regular injection
Figure 3. Huge skin lipohypertrophy. Large LH nodules at the middle-
distal portion of both thighs after repeated injections into the same site. site rotation and no needle reuse, taking a relatively long
Source: Photo taken by the authors. period of time for LH lesion resolution, which is subjected
to LH nodule size (Frid et al., 2016).
release asynchronous from meal-related needs (Blanco Considering that five education sessions can be
et al., 2013; Gentile et al., 2020; Gentile & Strollo, 2018); reimbursed with 30 € by the NHS and can be repeated
(ii) large glycemic variability and poor metabolic control; twice a year, such an interventional strategy is well
(iii) accelerated development of chronic complications of justified for implementation given the tremendous
diabetes (Gentile et al., 2020; Gentile et al, 2021a); and number of hypoglycemic events can be prevented and
(iv) a heavy economic and social burden stemming from related costs that can be reduced (Gentile et al., 2021b;
the employment of home-based health-care providers, Gentile et al., 2021c; Gentile et al., 2022c). Compared to
emergency room utilization, and caregiver support.
liposuction, education-based approach is significantly less
4.3. Limitations expensive, and due to its mild nature, is associated with
lower invasiveness risk.
With the exception of the findings, we published in a
previous report (Gentile et al., 2023a), no data are available Nevertheless, more research findings, from the angle
in the literature regarding the decimation of LH nodules of esthetic medicine, in support of liposuction as a viable
through education-based approaches. therapeutic solution for LH patients are warranted to
explore liposuction as a viable treatment option in much
In addition, no scientifically grounded data about the
utilization frequency of the various nodule liposuction urgent cases.
techniques are available in the literature; therefore, more Acknowledgements
research is warranted to address this gap.
We are deeply indebted to Dr. Liberata Paola Murano for
In this paper, the comparison of the costs of liposuction her complimentary editorial assistance. A special thank
and education is presented. you is also due to the patients who agreed to have their

5. Conclusion pictures published.
Among the proposed several treatment approaches, Funding
injection site rotation stands as the most viable solution, None.
to avoid repeated traumas or generation of insulin-
related anabolic signals that induce macro-adipocyte Conflict of interest
differentiation and fibrous reactions, so as to suppress the
development of LH (Blanco et al., 2013; Fujikura et al., The authors declare no conflicts of interest.
2005). Corticosteroids, liposuction, and aesthetic surgery Author contributions
do not always yield the most significant therapeutic
outcomes, but they might be beneficial in particular cases, Conceptualization: All authors
such as the occurrence of very large LH nodules (Blanco Writing – original draft: All authors
et al., 2013; Gentile et al., 2020) (Figure 3). Writing – review & editing: All authors

Volume 2 Issue 2 (2024) 5 https://doi.org/10.36922/ghes.2424