{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:23:16Z","timestamp":1788276196875,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T00:00:00Z","timestamp":1644537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Diabetes Invest"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims\/Introduction<\/jats:title><jats:p>The influence of repeated insulin injection on subcutaneous tissue is known, but its impact on the skin is unclear. Therefore, this study aimed to elucidate the impact of repeated insulin injections on the skin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>The properties of the skin and the subcutaneous tissue were evaluated in 52 insulin\u2010treated adult patients with diabetes with abnormal findings at the site of self\u2010injection (36 with subcutaneous nodules, 16 with suspected subcutaneous tissue induration) by ultrasonography. In all subjects, both normal and abnormal areas were examined. In addition, skin biopsies were performed in four subjects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The skin thickness of the normal and abnormal skin sites was 1.95 (1.60, 2.50) and 2.80 (2.27, 3.30) mm, respectively (median (first quartile, third quartile)), (<jats:italic>P\u2009<\/jats:italic>&lt;\u20090.001). The biopsy specimens revealed slightly thickened and tight bundles of collagen in the dermis. Three patients had amyloid deposits in the subcutaneous tissue, and one also showed these in the dermis. These were positively stained for insulin antibody.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Repeated insulin injection procedures result in skin thickening. Increased collagen fibers and possibly amyloid deposition in the dermis may be involved. The results reaffirmed the importance of appropriate site rotation in insulin injection and revealed the usefulness of ultrasonographic skin examination in evaluating the self\u2010injection procedure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdi.13753","type":"journal-article","created":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T09:34:22Z","timestamp":1642757662000},"page":"997-1003","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Repeated insulin injection without site rotation affects skin thickness \u2013 ultrasonographic and histological evaluation"],"prefix":"10.1111","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7259-574X","authenticated-orcid":false,"given":"Satoshi","family":"Murao","sequence":"first","affiliation":[{"name":"Department of Metabolism and Endocrinology Takamatsu Hospital  Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazutoshi","family":"Murao","sequence":"additional","affiliation":[{"name":"Department of Dermatology Tokushima University Graduate School of Biomedical Sciences  Tokushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Nagata","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine Takamatsu Hospital  Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misato","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine Takamatsu Hospital  Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumi","family":"Miyai","sequence":"additional","affiliation":[{"name":"Department of Pathology and Host Defense Faculty of Medicine Kagawa University  Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,2,11]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-S009"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-S301"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.2165\/00128071-200304100-00001"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2017.08.013"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrd.2015.36"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-020-00876-0"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2013.10.029"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-0610"},{"key":"e_1_2_6_10_1","first-page":"104","article-title":"Ultrasonographic aspect of subcutaneous tissue dystrophies as a result of insulin injections","volume":"12","author":"Perciun R","year":"2010","journal-title":"Med Ultrason"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-017-0675-1"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2017.06.011"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13764"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007995.2010.481203"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2014.0111"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.2337\/cd18-0076"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2040-1124.2010.00074.x"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2004.019547"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.13199"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60041-6"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13346-015-0239-x"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1089\/dia.2016.0156"}],"container-title":["Journal of Diabetes Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jdi.13753","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jdi.13753","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jdi.13753","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T17:40:49Z","timestamp":1692639649000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jdi.13753"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,11]]},"references-count":21,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1111\/jdi.13753"],"URL":"https:\/\/doi.org\/10.1111\/jdi.13753","archive":["Portico"],"relation":{},"ISSN":["2040-1116","2040-1124"],"issn-type":[{"value":"2040-1116","type":"print"},{"value":"2040-1124","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,11]]},"assertion":[{"value":"2021-09-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-02-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}