Lipodystrophy and associated factors among patients with diabetes receiving insulin therapy: a multicenter study in Ethiopia

Abstract Lipodystrophy alters insulin absorption, potentially leading to unpredictable hypoglycemia and inadequate glycemic control. Although the problem is long known, it continues to persist and remains neglected, particularly among diabetic patients in developing countries. This study evaluated its magnitude and different contributing factors. This study aimed to assess the prevalence of lipodystrophy, and their contributing factors among patients receiving insulin therapy in three selected hospitals of Northwest Ethiopia. A cross-sectional study was conducted from April 5 to September 30, 2023, at the University of Gondar, Tibebe ghion and Debre Markos Comprehensive Specialized Hospitals. Standardized physical examinations were used to assess the presence of lipodystrophy and data on demographic characteristics, clinical characteristics, and drug related characteristics were used for analysis. Logistic regression was used to identify factors associated with lipodystrophy. Among participants, 54.3% had type 1 diabetes mellitus. The larger part of study participants (71.5%) reported having diabetes mellitus for over five years. Insulin-induced lipodystrophy was observed in 225 cases (53.1%). Grade 2 lipohypertrophy was the most common type (52.7%), marked by significant fat thickening, while Grade 3 lipoatrophy was rare (1.8%). The abdomen was the most affected injection site (36.5%), followed by multiple sites (32%). Failure to rotate (AOR = 1.8, p-value 0.004), needle reuse, glycemic control (AOR = 2.15, p-value 0.019), and insulin dosage per kg (AOR = 2.1, p-value 0.001) were found to have an association with lipodystrophy. The study revealed a high prevalence of lipodystrophy among diabetic patients using insulin injections, highlighting the need for greater attention to ensure comprehensive diabetes care.