ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
ORIGINAL ARTICLE

Effect of Vitamin D Deficiency on the Frequency of Lipohypertrophy Occurrence in Patients with Type 2 Diabetes Mellitus Under Injectable Treatment
D Vitamini Eksikliğinin Enjeksiyon Tedavisi Alan Tip 2 Diabetes Mellitus Hastalarında Lipohipertrofi Sıklığına Etkisi
Received Date : 23 Feb 2020
Accepted Date : 14 Jun 2020
Available Online : 29 Jun 2020
Doi: 10.25179/tjem.2020-74469 - Makale Dili: EN
Turk J Endocrinol Metab. 2020;24:184-188
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Lipohypertrophy (LH) is one of the most common treatment-related cutaneous complications of injectable therapies. Although the etiology of LH cannot be clarified, it may be due to the lipogenic effect of insulin or recurrent tissue trauma caused by injections. In this respect, we aimed to evaluate the relationship between vitamin D level and LH. Material and Methods: Patients with Type 2 diabetes mellitus aged 18 years or older, who were under insulin and/or exenatide treatment for at least one year were included in this study. The injection sites of the patients were examined by inspection and palpation method. Patients were categorized into two groups according to vitamin D levels as below and above 20 ng/mL. Results: A total of 140 patients, including 91 women and 49 men, aged between 20-78 years with a mean age of 54.53±13.89 were included in the study. LH was detected in 91 (65%) of 140 patients. This study demonstrated that there was a significant relationship between gender and LH. Statistically, the frequency of LH was higher in female patients (p=0.001). Further, a relationship between vitamin D levels and LH was also observed (p=0.006). Conclusion: Besides calcium metabolism, the effects of vitamin D on lipogenesis are also known. Vitamin D inhibits the differentiation of pre-adipocytes to mature adipocytes. This is the first study showing the relationship between vitamin D and LH in our knowledge.
ÖZET
Amaç: Lipohipertrofi (LH), enjekte edilebilir tedavilerin, tedaviyle ilişkili en yaygın kutanöz komplikasyonlarından biridir. LH’nin etiyolojisi tam olarak açıklanamasa da, insülinin lipojenik etkisinden veya enjeksiyonun neden olduğu tekrarlayan doku travmasından kaynaklandığı düşünülmektedir. Bu bağlamda D vitamini ve LH arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: En az 1 yıl boyunca insülin ve/veya eksenatid tedavisi kullanan 18 yaş ve üzeri Tip 2 diabetes mellitus tanılı hastalar çalışmaya dâhil edildi. Hastaların enjeksiyon bölgeleri inspeksiyon ve palpasyon yöntemi ile incelendi. Hastalar, D vitamini seviyelerine göre 20 ng/mL’nin altında ve üstünde olmak üzere iki gruba ayrıldı. Bulgular: Yaş ortalaması 54.53±13.89 yıl olan 20-78 yaşları arasında 91’i kadın, 49’u erkek toplam 140 hasta çalışmaya dâhil edildi. 140 hastanın 91 (%65)’inde LH saptandı. Bu çalışma, cinsiyet ile LH arasında anlamlı bir ilişki olduğunu göstermekteydi. İstatistiksel olarak kadınlarda LH sıklığının daha fazla olduğu görüldü (p=0.001). D vitamini düzeyleri ile LH arasında da anlamlı bir ilişki vardı (p=0.006). Sonuç: Kalsiyum metabolizması üzerindeki etkilerine ek olarak, D vitamininin lipogenez üzerindeki etkileri de bilinmektedir. D vitamini, preadipositlerin olgun adipositlere farklılaşmasını inhibe eder. Bu makale, bilgimiz dâhilinde D vitamini ile LH arasındaki ilişkiyi gösteren ilk çalışmadır.
KAYNAKLAR
  1. International Diabetes Federation. IDF Diabetes Atlas. 7th ed. Available from: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/13-diabetes-atlas-seventh-edition.html (Last update December 13, 2017.)
  2. Mohan V, Shah SN, Joshi SR, Seshiah V, Sahay BK, Banerjee S, Wangnoo SK, Kumar A, Kalra S, Unnikrishnan AG, Sharma SK, Rao PV, Akhtar S, Shetty RV, Das AK, DiabCare India 2011 Study Group et al. Current status of management, control, complications and psychosocial aspects of patients with diabetes in India: Results from the DiabCare India 2011 Study. Indian J Endocrinol Metab. 2014;18:370-378. [Crossref]  [PubMed]  [PMC] 
  3. Blanco M, Hernández MT, Strauss KW, Amaya M. Prevalence and risk factors of lipohypertrophy in insulin-injecting patients with diabetes. Diabetes Metab. 2013;9:445-453. [Crossref]  [PubMed] 
  4. Hanuer H, Stockamp B, Haastert B. Prevalence of lipohyperthyropy in insulin-treated diabetic patients and predisposing factors. Exp Clin Endocrinol Diabetes. 1996;104:106-110. [Crossref]  [PubMed] 
  5. Gentile S, Strollo F, Guarino G, Diabetologists; Nurses. Why are so huge differences reported in the occurrence rate of skin lipohypertrophy? Does it depend on method defects or on lack of interest? Diabetes Metab Syndr. 2019;13:682-686. [Crossref]  [PubMed] 
  6. Barola A, Tiwari P, Bhansali A, Grover S, Dayal D. Insulin-related lipohypertrophy: lipogenic action or tissue trauma? Front Endocrinol (Lausanne). 2018;9:638. [Crossref]  [PubMed]  [PMC] 
  7. Gentile S, Strollo F, Ceriello A, AMD-OSDI Injection Technique Study Group. Lipodystrophy in insulin-treated subjects and other injection-site skin reactions: are we sure everything is clear? Diabetes Ther. 2016;7:401-409. [Crossref]  [PubMed]  [PMC] 
  8. Nair R, Maseeh A. Vitamin D: the 'sunshine' vitamin. J Pharmacol Pharmacother. 2012;3:118-126.
  9. Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, Michigami T, Tiosano D, Mughal OM, Ramos-Abad L, Ward L, DiMeglio LA, Atapattu N, Cassinelli H, Braegger C, Pettifor JM, Seth A, Idris HW, Bhatia V, Fu J, Goldberg G, Sävendahl L, Khadgawat R, Pludowski P, Maddock J, Hyppönen E, Oduwole A, Frew E, Aguiar M, Tulchinsky T, Butler G, Högler W. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets. J Clin Endocrinol Metab. 2016;101:394-415. [Crossref]  [PubMed]  [PMC] 
  10. Norman PE, Powell JT. Vitamin D and cardiovascular disease. Circ Res. 2014;114:379-393. [Crossref]  [PubMed] 
  11. Murdaca G, Tonacci A, Negrini S, Greco M, Borro M, Puppo F, Gangemi S. Emerging role of vitamin D in autoimmune diseases: An update on evidence and therapeutic implications. Autoimmun Rev. 2019;18:102350. [Crossref]  [PubMed] 
  12. Kulling PM, Olson KC, Olson TL, Feith DJ, Loughran Jr TP. Vitamin D in hematological disorders and malignancies. Eur J Haematol. 2017;98:187-197. [Crossref]  [PubMed]  [PMC] 
  13. Borges CC, Salles AF, Bringhenti I, Mandarim-DE-Lacerda CA, Aguila MB. Vitamin D deficiency increases lipogenesis and reduces beta-oxidation in the liver of diet-induced obese mice. J Nutr Sci Vitaminol (Tokyo). 2018;64:106-115. [Crossref]  [PubMed] 
  14. Kang EJ, Lee JE, An SM, Lee JH, Kwon HS, Kim BC, Kim Sj, Kim JM, Hwang DY, Jung YJ, Yang SY, Kim SC, An BS. The effects of vitamin D3 on lipogenesis in the liver and adipose tissue of pregnant rats. Int J Mol Med. 2015;36:1151-1158. [Crossref]  [PubMed] 
  15. Chang E, Kim Y. Vitamin D decreases adipocyte lipid storage and increases NAD-SIRT1 pathway in 3T3-L1 adipocytes. Nutrition. 2016;32:702-708. [Crossref]  [PubMed] 
  16. Fujikura J, Fujimoto M, Yasue S, Noguchi M, Masuzaki H, Hosoda K, Tachibana T, Sugihara H, Nakao K. Insulin-induced lipohypertrophy: report of a case with histopathology. Endocr J. 2005;52:623-628. [Crossref]  [PubMed] 
  17. Lee CJ, Iyer G, Liu Y, Kalyani RR, Bamba N, Ligon CB, Varma S, Mathioudakis N. The effect of vitamin D supplementation on glucose metabolism in type 2 diabetes mellitus: a systematic review and meta-analysis of intervention studies. J Diabetes Complications. 2017;31:1115-1126. [Crossref]  [PubMed]  [PMC] 
  18. Ordooei M, Shojaoddiny-Ardekani A, Hoseinipoor SH, Miroliai M, Zare-Zerdini H. Effect of vitamin D on HbA1c levels of children and adolescents with diabetes mellitus type 1. Minerva Pediatr. 2017;69:391-395.
  19. Aljabri KS, Bokhari SA, Khan MJ. Glycemic changes after vitamin D supplementation in patients with type 1 diabetes mellitus and vitamin D deficiency. Ann Saudi Med. 2010;30:454-458. [Crossref]  [PubMed]  [PMC] 
  20. Dagdelen S, Deyneli O, Olgun N, Siva ZO, Sargin M, Hatun S, Kulaksızoğlu M, Kaya A, Gürlek CA, Hirsch LJ, Strauss KW, ITQ Turkish Study Group. Turkish insulin injection techniques study: complications of injecting insulin among turkish patients with diabetes, education they received, and the role of health care professional as assessed by survey questionnaire. Diabetes Ther. 2018;9:1615-1628. [Crossref]  [PubMed]  [PMC] 
  21. Vardar B, Kizilci S. Incidence of lipohypertrophy in diabetic patients anda study of influencing factors. Diabetes Res Clin Pract. 2007;77:231-236. [Crossref]  [PubMed]