Background
Patients with T1DM need insulin continously for indefinite duration while the need for insulin in T2DM is the function of the stage in the natural history of T2DM  
Aim
We aimed to study the incidence lipohypertrophy (LH) in T1DM and T2DM patients on ongoing insulin therapy and intervene through education to modulate the reduction of this avoidable complication 
Method
We analysed the data of 141 patients (TIDM n=85, T2DM n=56) from the institutional clinical database. These patients were followed up and intervened through a customized education module for the need for injection site rotation, LH self inspection and the prevention of needle reuse. Fisher's exact test was used for the statistical analysis
Results
The mean age of T1DM was 19.92 yrs (minimum 5- maximum 56 yrs) and T2DM were 51.02 yrs (minimum 28-maximum 75 yrs). Almost all (96%) of the patients were utilizing the established branded needle which has been the market leader in the country. The mean daily units of insulin in T1DM were 44.52 (minimum 15- maximum 85) and in T2DM patients the mean units were 40.54 units (minimum 16- maximum 120). In T1DM patients  approximately every other patient (45.9%) 54/85 used to rotate injection site while in T2DM every 2 out of 3 patient (69%) 39/56 were used to do practice the site rotation. The incidence of LH was 78.8% (67/85) in  T1DM and was 39 % (22/56) in T2DM, the difference was statistically significant (p=0.0223). 94 % (63/67) of the patients who reported LH were aware of the complication of LH but were not precisely aware that this could be well avoided by following a simple practice of site rotation. In contrast, the level of awareness was less (68%) in T2DM who reported LH with only 15 patients aware of LH. The difference in the awareness between T1DM and T2DM was not statistically significant (p=0.457). Despite the reporting of LH in T1DM 34 out of 67 patients used to inject insulin at the same site while 15 out of 22 patients who reported LH in T2DM were injecting at the same. Overall, in T1DM 54/85 were aware of occurrence of LH whereas in T2 DM only 15/56 were aware about LH. (p=0.0126 was significant). We intervened with the customized patient coaching to increase the awareness for the need for site rotation, lipohypertrophy, self inspection of the injection site and prevention of needle re-use. 
Discussion
We observed LH is more common in T1DM as compared to T2DM. However, the awareness level for LH is less in T2DM. Importantly, even in the group aware of LH, the patients continued to inject at the same site. Therefore, a triple multipronged approached is needed to decrease the incidence of LH, for the treating physician be vigilant for detecting LH by periodic examination at the injection site, the education program directed towards the patients need to be further intensified for emphasis on the need for site rotation, needle re use and self inspection of injection site and with specific efforts to continuously motivate the patient to follow the good practice of site rotation

Education intervention to reduce lipohypertrophy - an avoidable complication in T1DM and T2DM