{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T23:42:16Z","timestamp":1788910936152,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"17-18","license":[{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Administration of insulin may be associated with substantial cutaneous adverse effects, such as lipoatrophy and lipohypertrophy (LH), which can cause glycemic excursions above and below the target levels for blood glucose. Our aim was to evaluate the effect on compliance with the use of insulin administration site, dermatological complications and diabetes management in children with type 1 diabetes (T1D).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients aged 0<jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/jocn16071-math-0001.png\" xlink:title=\"urn:x-wiley:09621067:media:jocn16071:jocn16071-math-0001\"\/>21\u00a0years who were followed up with the diagnosis of T1D for at least one year were included. A 14\u2010question survey including demographic characteristics and a subjective opinion of skin\u2010related complications of insulin administration was given. Data were obtained from the medical records to evaluate the effect of dermatological complications on diabetes management. This study was checked with the STROBE checklist.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two hundred and fifty\u2010four patients were included and 53% of these were female. The mean age was 14.9\u00a0\u00b1\u00a04.7\u00a0years and the duration of T1D was 7.3\u00a0\u00b1\u00a04.1\u00a0years. The mean HbA1c level was 8\u00a0\u00b1\u00a01.4% and the mean total insulin dose was 0.84\u00a0\u00b1\u00a00.25\u00a0units\/kg\/day. More than half of the individuals (57%) were receiving multiple daily injections (MDI) and 43% were on insulin pump therapy (IPT). Of the participants, 11.8% reported LH, 7.5% wound, 21.7% allergy, 55.5% bleeding, 41.3% bruising and 47.2% pain. LH rates varied significantly by regimen, 17.1% in MDI and 4.6% with IPT (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.001). Those with LH were using higher median doses of insulin (0.97 U\/kg\/day) than those who did not (0.78\u00a0U\/kg\/day; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.016). LH was reported more frequently (18.3%) in patients with frequent hypoglycemia (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.007). Positive correlation between BMI\u2010SDS and LH in patients aged &lt;18\u00a0years was found (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.043). LH rates by site were: right arm 20.8%, left arm 26.4%, right abdomen 26.4%, left abdomen 22.6% and 1% in the right and left leg.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Local complications of insulin therapy are common in young patients with T1D. The complication with the most impact on metabolic control was LH, present in nearly 12% of patients. Users of IPT have a significantly lower risk of LH. The results emphasise the importance of individualised education for young T1D patients and their families about injection site preference and rotation techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to clinical practice<\/jats:title><jats:p>The diabetes team should check the insulin administration sites of children with type 1 diabetes at each visit and provide repeated education about the dermatological complications of insulin.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocn.16071","type":"journal-article","created":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T01:42:57Z","timestamp":1633830177000},"page":"2530-2538","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Local complications of insulin administration sites and effect on diabetes management"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1468-1647","authenticated-orcid":false,"given":"G\u00fcnay","family":"Demir","sequence":"first","affiliation":[{"name":"Division of Pediatric Endocrinology Department of Pediatrics School of Medicine Ege University  \u0130zmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eren","family":"Er","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology Department of Pediatrics School of Medicine Ege University  \u0130zmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasemin","family":"Atik Alt\u0131nok","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology Department of Pediatrics School of Medicine Ege University  \u0130zmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samim","family":"\u00d6zen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology Department of Pediatrics School of Medicine Ege University  \u0130zmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u015e\u00fckran","family":"Darcan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology Department of Pediatrics School of Medicine Ege University  \u0130zmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damla","family":"G\u00f6k\u015fen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology Department of Pediatrics School of Medicine Ege University  \u0130zmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12698"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.5812\/ijem.20776"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300\u2010016\u20100161\u20103"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2013.05.006"},{"key":"e_1_2_11_6_1","first-page":"339","article-title":"Evaluation of 2\u2010year follow\u2010up results and compliance to treatment of children and adolescents with type 1 diabetes mellitus receiving flexible insulin therapy","volume":"14","author":"\u00c7elik P.","year":"2020","journal-title":"Turkish Journal of Pediatric Disease"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7411.383"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2007.10.006"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12718"},{"issue":"2","key":"e_1_2_11_10_1","first-page":"64","article-title":"Lipohypertrophy \u2013 A complication of insulin injections","volume":"11","author":"De Villiers F. 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