Lipoatrophy associated with the use of insulin analogues: a new case associated with the use of insulin glargine and review of the literature

Abstract

Importance of the field: Any insulin formulation can in principle cause lipoatrophy; even cases associated with recombinant human insulin have been reported. An increasing number of case reports have been published indicating that lipoatrophy also develops after treatment with various insulin analogues.

Areas covered in this review: In this review, we summarise the literature on lipoatrophy associated with the use of insulin analogues published to date. A new case of lipoatrophy associated with the use of glargine is presented.

What the reader will gain: Readers will gain insight into: i) pathogenesis of lipoatrophy associated with the use of insulin analogues and ii) clinical features of lipoatrophy.

Take home message: Twelve cases with lipoatrophy under treatment with insulin analogues have been reported so far. The exclusive occurrence in lean type 1 diabetic patients, its overlap with further autoimmune diseases and the overrepresentation of female individuals point to an immune pathogenesis. The respective exposition to the analogues lispro, aspart, glargine and detemir prior to lipoatrophy development varied considerably between 4 weeks and 2 years. No spontaneous substantial recovery of lipoatrophic areas has been reported. Frequent use of the same pen needle and lack of rotating of insulin injection sites seem to favour the development of lipoatrophy.

Keywords::

• diabetes
• glargine
• insulin
• insulin analogues
• lipoatrophy

Acknowledgements

The authors thank T Heise, Profil Institut für Stoffwechselforschung, Neuss, Germany, for critically reviewing our manuscript and for his helpful suggestions.

Notes

This box summarises key points contained in the article.