Endocrine Abstracts

Introduction: Lipohypertrophy (LH) is common in children and young people (CYP) with diabetes on both insulin injection and infusion therapy. Suboptimal injection and rotation, the presence of LH as well as increased use of insulin have all been associated with glycaemic variability, hypoglycaemia and raised HbA1c. Evidence based and data driven recommendations led to the Forum for Injection Technique 4th edition UK consensus document (FIT 2016). The latest edition also includes insulin infusion and psychological recommendations which have the potential to influence and enhance self-care behaviours and optimise health outcomes.

Methods: Contribution to an international audit provided a unique opportunity to benchmark local knowledge and skills in injection and infusion technique, rotation and LH detection against a dataset involving over 13000 participants. Interactive workshops comprising modelling by trained experts aided by real life volunteers with diabetes enabling hands on experience. This approach facilitated a unique opportunity to hone clinical examination technique in a safe learning environment with protected time.

Results: Real life examinations integrated with critical awareness of the evidence base provided opportunities for structured reflection on clinical practice. HCP’s distinguished changes in skin texture due to LH whilst differentiating between muscle definition, the presence of faeces in the bowel, injection and infusion LH (more subtle in the latter) as well as locating transition zones to establish and monitor LH mass size.

Discussion / Conclusion: Notable benefits include tangible changes in routine care provision and enablement of self-management behaviours in this core aspect of diabetes care.

Enhancement of self-care behaviours including more frequent site examination (to detect and prevent LH) and infusion site management (to expose and act on silent occlusions earlier, minimising interruptions to insulin flow) have the potential to further reduce the burden of care and optimise overall health outcomes.