Ultrasound Technology for Detecting Lipohypertrophy in Diabetes

Recruiting in Palo Alto (17 mi)

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: University of British Columbia

No Placebo Group

Trial Summary

What is the purpose of this trial?Lipohypertrophy is swelling of the fatty tissue located below the skin ("subcutaneous tissue") where many patients with diabetes inject their insulin. Lipohypertrophy can sometimes be felt as firm swelling, lumps or small bumps near insulin injection sites. Previous studies have shown that injecting insulin into areas of lipohypertrophy can affect how insulin is absorbed, and can increase insulin requirements in patients. New data suggest that lipohypertrophy can be detected using ultrasound technology. The ultrasonographic presence of changes to the subcutaneous tissue without swelling that can be felt ("subclinical lipohypertrophy") and the effect of injecting insulin into these sites is unknown. 100 people will participate in the Phase 1 of this study. In the second phase of the study, 40 patients identified with subclinical lipohypertrophy in Phase 1 will be asked to participate in the randomized study using crossover design by checking your glucose levels.

Eligibility Criteria

This trial is for people with Type 1 or Type 2 diabetes who have been treating it with at least one daily insulin injection or an insulin pump for over two years. It's not open to those who've had skin conditions other than lipohypertrophy near their insulin injection sites, or are on certain diabetes medications like GLP-1 agonists.

Inclusion Criteria

Current treatment with a minimum of one insulin injection daily or insulin pump for at least 2 years

You have a diagnosis of Type 1 or Type 2 diabetes mellitus.

Exclusion Criteria

You have had a skin condition in areas where insulin is usually injected.

You are currently taking medication called glucagon-like peptide-1 agonist or systemic glucocorticoid.

Participant Groups

The study tests if using ultrasound to detect 'subclinical lipohypertrophy'—unseen changes in the fatty tissue where insulin is injected—affects how well the body uses insulin. In Phase 2, patients with these ultrasound-detected changes will monitor their glucose levels to see if avoiding these areas improves glycemic control.

2Treatment groups

Experimental Treatment

Active Control

Group I: LH ProtocolExperimental Treatment1 Intervention

Group II: Normal ProtocolActive Control1 Intervention

Patients will be randomized and data interpreters will be blinded to two, randomized, alternating 14-day protocols where the patients will be advised by the nurse educator verbally and by written instruction to inject insulin in sites of normal subcutaneous tissue. Outcomes measured will consist of mean glucose, glucose standard deviation around the mean value, percentage of time with glucose below 3 mmol/liter, and percentage of time spent with glicose above 10 mmol/liter. The device will be calibrated and placed by a trained research nurse. There will be a member of the rsearch team available 24 hours per day to answer subject questions.