- ERA 2023 - Clinical-functional kidney-lung link in a population of hemodialyzed patients
- Lipodystrophies from Insulin Injection: An Update of the Italian Consensus Statement of AMD-OSDI Study Group on Injection Technique
- Insulin-induced lipohypertrophy and factors affecting it in children and adolescents with type 1 diabetes mellitus: Review of the literature from the past 12 years: An appraisal and extension to adult subjects
- Insulin Injection-Related Skin Lipodystrophies: Blemish or Pathology?
Published: 14 June 2023
We know that lung and kidney are intimately related from a functional standpoint, both in physiological conditions and in diseases. The close relationship between lung and kidney (kidney-lung link) is evidence of a homeostatic connection between all organs and systems in an attempt to maintain the body system balance. In a recent review  we emphasized the importance to search for the clinical signs of a disease not only in the primary affected organ but also in organ functionally related.
For this purpose we examined 81 hemodialyzed patients, with a mean age of 66.6 ± 13 years (28 f and 53 M), undergoing hemodialysis treatment (mean dialysis: 96 ± 34 months), with regard to smoking habits (47 non-smokers and 34 smokers with an average of 19.8 cigarettes per day: pack / years: 33.4 ± 2.9). Pulmonary function test (PFT) and clinical signs were evaluated. we excluded 6 patients (4 males and 2 females) in the smoking group with obstructive spirometric pattern (detected by a FEV1.0/FVC ratio lower than 70 absolute value), so that the final non-smoking group consisted of 47 patients and the smoking-group by 28 smokers: both groups matched for anthropomorphic data.
The mean values of PFT were globally no different between smokers with normal PFT and non smokers are summarized in Table 1: Although the never-smoking group was nearly twice as large as the smokers, and PFT were similar and normal, respiratory symptoms were predominant: daily cough (49 yes; 26 no); chronic phlegm (51 yes; 24 no).
in dialysis patients, cough and phlegm are common symptoms, regardless of smoking and spirometric values. Probably these results are the consequence of synergistic effects between lungs and kidneys, as recently demonstrated . Hence the need to evaluate dialysis patients from the clinical-functional point of view of both, kidneys and lungs, in order to evaluate the appropriate, personalized, therapeutic strategy according to the last evidences of the literature .
1. Satta E et al. Kidney and lung in pathology: mechanisms and clinical implications. Multidiscip Respir Med. 2022 17(2):819.
2. Polverino F et al. A pilot study linking endothelial injury in lungs and kidneys in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2017 195(11):1464–76.
3. Polverino F et al. Metformin: experimental and clinical evidence for a potential role in emphysema treatment. Am J Respir Crit Care Med. 2021 204(6):651–66.
Lipodystrophies from Insulin Injection: An Update of the Italian Consensus Statement of AMD-OSDI Study Group on Injection Technique
by Sandro Gentile 1,2,*ORCID, Ersilia Satta 1, Giuseppina Guarino 1,2 and Felice Strollo 3 ORCID on behalf of the AMD-OSDI Study Group on Injection Technique
1 Nefrocenter Research, 84013 Cava dè Tirreni, Italy
2 Department of Internal Medicine, Campania University “Luigi Vanvitelli”, 80138 Naples, Italy
3 Endocrinology and Diabetes Department, IRCCS, San Raffaele Pisana, 00163 Rome, Italy
*Author to whom correspondence should be addressed.
Diabetology 2023, 4(1), 119-127; https://doi.org/10.3390/diabetology4010013
Insulin-induced lipohypertrophy and factors affecting it in children and adolescents with type 1 diabetes mellitus: Review of the literature from the past 12 years: An appraisal and extension to adult subjects
Felice Strollo 1, Ersilia Satta 2, Luisa Borgia 4 and Sandro Gentile 2, 3, *
1 Department of Endocrinology and Diabetes, IRCCS San Raffaele Pisana, Via Val Cannuta, 247, I-00166, Italy.
2 Research Department of Nefrocenter Research, Via XXV Lulio 160, Cava de Tirreni, I-84013 (Salerno), Italy.
3 Department of Internal Medicine, Luigi Vanvitelli University of Campania, Via Pansini, 5 – I-80131 Naples, Italy.
4 Department of Life and Environmental Sciences, Marche Polytechnic University, Piazza Roma,22 I-60121 Ancon, Italy.
Our research group has dealt with injection-induced lip hypertrophy (IILH) in insulin-treated subjects for over a decade, focusing on causes and consequences, education, prevention and treatment, comorbidities, and related complications. Stimulated by an excellent Review that recently appeared on the pages of this Journal, we want to contribute insight into IILH. This brief Commentary underlines some key concepts on how to identify, prevent and cure them, pointing out salient aspects derived from our research to provide the scientific community with an as complete as possible overview of evidence-based knowledge and highlight the need for further experimental insights.
Keywords: Diabetes mellitus; Insulin injection; Injection technique; Lipodystrophy; Lipohypertrophy
World Journal of Advanced Research and Reviews, 2023, 17(01), 596–604 Article DOI: https://doi.org/10.30574/wjarr.2023.17.1.0074
Insulin Injection-Related Skin Lipodystrophies: Blemish or Pathology?
Felice Strollo 1, Ersilia Satta 2 and Sandro Gentile 2,3,*
1 Endocrinology and Diabetes, IRCCS San Raffaele Pisana, I-00163 Rome, Italy
2 Nefrocenter Research & Nyx Start-Up, I-80030 Naples, Italy
3 Department of Internal Medicine, Luigi Vanvitelli University of Campania, I-50138 Naples, Italy
* Correspondence: firstname.lastname@example.org
Abstract: The number of adult individuals with insulin-treated diabetes mellitus (DM) is steadily increasing worldwide. The main local complications of insulin injection are lipohypertrophies (LHs), i.e., subcutaneous nodules consisting of aggregates of macro-adipocytes and fibrin. These nodules result from errors repeatedly made by patients while injecting insulin. Despite being very common, LH lesions/nodules due to incorrect insulin injection techniques are often flat and hardly visible and thus require thorough deep palpation examination and ultrasonography (US) for detection. Identifying LHs is crucial, especially in elderly and frail subjects, because they may eventually result in poor diabetes control due to associated unpredictable insulin release patterns. Raising awareness of the adequate detection of LHs and their clinical consequences is crucial and urgent. A call to action is required on this topic at all levels of undergraduate and postgraduate education.
Keywords: diabetes; insulin; injection technique; lipohypertrophy