Background Lipodystrophy (LH) is one of the most common complications of subcutaneous insulin injection. Many factors are incriminated in the evolution of LH in children with diabetes type 1 (T1DM). LH may affect insulin absorption in skin areas involved, resulting in negative impact on blood glucose levels and glycemic variability.

Aim of Study the aim to study Insulin-induced lipodystrophy and predisposing factors in children and adolescents with type 1 diabetes mellitus (T1DM) in a tertiary care Egyptian center

Methods We calculated evaluated the prevalence of LH in relation to possible clinical factors associated with the development of LH in a cohort of children (n =115) with T1DM using insulin pens or syringes and we studied possible predisposing factorsincluding their age, duration of T1DM, injection technique, insulin dose/kg, degree of pain perception, and HbA1c level.

Results In our cross-sectional study, 84% of patients were using pens for insulin injection and 52.2% of them were rotating the site of injec-tion on daily basis. 27% did not experience pain during injection while 6% had the worst hurt. 49.5% had clinically detectable LH. Those with LH had higher HbA1c level and more unexplained hypoglycemic events compared to those without LH (P: 0.058). The hypertrophied site was related to the preferred site of injection which was the arms in 71.9% of the cases. Children who had LH were older with longer duration of T1DM, rotating sites of injection less frequently and were more frequently reusing needles compared to children with-out LH (P: < 0.05).

Conclusion(s) Improper insulin injection technique, older age, and longer duration of T1DM were associated with LH. Proper education of patients and their parents must include correct injection tech- niques, rotating injection sites, and minimal reuse of needles.