Lipohypertrophy Diagnosis Often Missed on Physical Examination in Patients With Diabetes

woman injecting insulin
There is a high false-negative rate for lipohypertrophy diagnosis on physical examination in patients with type 1 or type 2 diabetes.

The following article is part of coverage from the American Diabetes Association’s 80th Scientific Sessions (ADA 2020). Because of concerns regarding the coronavirus disease 2019 (COVID-19) pandemic, all ADA 2020 sessions and presentations were transitioned to a virtual format. While live events will not proceed as planned, readers can click here to view more news related to research presented during the ADA 2020 virtual experience.

There is a high likelihood of missing lipohypertrophy on physical examination in patients with diabetes, according to study results presented during the American Diabetes Association’s 80th Scientific Sessions, held online from June 12 to 16, 2020.

Researchers completed a cross-sectional study to compare the prevalence of and risk factors for missed lipohypertrophy with the use of physical examination vs ultrasound scanning. A total of 260 patients with diabetes (mean age, 40.4 years; 52.7% men; 50.8% with type 1 diabetes) who had used insulin continuously for ≥1 year were included. Lipohypertrophy was confirmed on ultrasound by presence of subcutaneous fat layer thickening, increased echogenicity in diffuse areas, and nodular hyperechoic foci.

Overall, 210 patients (80.8%) were diagnosed with lipohypertrophy using ultrasound scanning. On physical examination, 128 patients were correctly diagnosed with lipohypertrophy but 82 cases were missed, equaling a false-negative rate of 39.0% for physical inspection and palpation alone. Duration of insulin therapy (odds ratio [OR], 0.84; P <.001), body mass index (OR, 3.02; P =.005), and site rotation (OR, 3.67; P <.001) were all associated with incorrect diagnosis.

“Physical examination was associated with a high rate of missed [lipohypertrophy] diagnosis for patients [who] received insulin for a short duration [and those who had higher body mass index],” stated the study authors. “Ultrasound scanning should be used as a complementary technique.”


Xu J, Luo D, Wang H, Zhu M, Shi Y. Missed diagnosis of lipohypertrophy by inspection and palpation: prevalence and contributing risk factors. Presented at: American Diabetes Association 80th Scientific Sessions; June 12-16, 2020. Abstract 674-P.

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