Psychological characteristics of eating disorders as evidenced by the combined administration of questionnaires and two projective methods: the Tree Drawing Test (Baum Test) and the Sentence Completion Test.

BACKGROUND

Lipohypertrophy (LH) is a common complication of insulin-treated diabetes; however, its prevalence and risk factors in people using continuous subcutaneous insulin infusion (CSII) remain insufficiently characterized. This study aimed to determine the prevalence and severity of LH and to identify the associated risk factors in individuals with type 1 diabetes mellitus (T1DM) treated with CSII or multiple daily injections (MDI).

METHODS

A total of 121 individuals with T1DM who received insulin therapy for at least one year were included (CSII, n = 43; MDI, n = 78). The presence and severity of LH (non-LH, mild, moderate, or severe) were assessed using the methods described by Ucieklak et al. Clinical characteristics were extracted from medical records, and diabetes self-management variables were collected using self-reported questionnaires.

RESULTS

The distribution of LH severity did not differ significantly between the CSII and MDI groups (CSII: 41.9% non-LH, 20.9% moderate, and 37.2% severe; MDI: 46.2%, 17.9%, and 35.9%, respectively; p = 0.908). In the CSII group, diabetic peripheral neuropathy (DPN) was associated with higher odds of LH (OR 12.3, 95% CI: 1.3-1651; p = 0.025). In addition, the total daily insulin dose differed significantly across LH severity categories (p = 0.049). In the MDI group, individuals with LH had a younger age at diagnosis and tended to have a longer duration of diabetes and insulin treatment than those without LH.

CONCLUSIONS

LH is highly prevalent among individuals with T1DM treated with either CSII or MDI. Distinct risk factors were identified according to the insulin delivery method, with DPN associated with severe LH in CSII users, and longer disease duration associated with LH in MDI users. These findings support targeted screening strategies to improve LH detection and prevent related complications.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s13340-026-00928-z.