Submit Manuscript | http://medcraveonline.com Mini review Cutaneous lipodystrophy (LD) has been known for decade’s ad many authors described LD in insulin-treated patients. Lipohypertrophy (LH) is well documented to be its most frequent form as opposed to lipoatrophy (LA). 1,2 A large body of evidence supports that LH is signifcantly associated to a series of parameters including female sex, low cultural level, high BMI, long duration of both disease and insulin treatment, use of long needles and, most of all, missed injection site rotation or repeated needle re-use. This topic is of great clinical interest indeed and, based on the evidence from 300 relevant related publications, was examined in depth by 150 top specialists from 58 countries at the Forum for Injection Technique & Therapy Expert Recommendations (FITTER), an international meeting held in Rome in October 2015. 3 At the end of three intensive working days during which all delegates exchanged their experienced knowledge in the feld, several recommendations were issued and have just been submitted for publication on an international scientifc journal. Nevertheless a wide variation has been reported in the literature concerning LH frequency, ranging in fact from 28% to 67%, 1,2 probably depending on the fact that a thorough skin examination is often omitted in diabetes clinics. However it should be pointed out that such variability may also be due to different levels of experience attained by involved health professionals (HPs), as well as, to the lack of a clearly defned, validated methodology devoted to LH identifcation. In fact, morphological features of such lesions are extremely variable in size, texture and protrusion above the skin. 4 The hereby attached Figure 1 refers to a some of our patients with diabetes and ultrasound-ascertained LH undergoing blind palpation-based examination by four well trained (WT) and as many non-trained (NT) HPs. It provides evidence of striking differences in the diagnostic ability between WT and NT HPs, being infuenced primarily by training level and by individual LD morphological features as well. Figure 1 Number of patients identifed as having LH by well trained (WT) or non-trained (NT) healthcare professionals (panel A) and number of well trained (green columns) or non-trained (red columns) health professionals, among 4 in each group, accurately identifying LH lesions (panel B) (* NT vs WT p<0.01). J Diabetes Metab Disord Control. 2016;3(3):53‒55. 53 © 2016 Gentile et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Insulin shot dependent lipodystrophy: evidence, uncertainties and current terminology overlaps Volume 3 Issue 3 - 2016 Sandro Gentile, 1 Antonio Ceriello, 2,3 Felice Strollo 4 on behalf of the AMD-OSDI Italian Injection Technique Study Group 1 Department of Clinical and Experimental Medicine, Second University of Naples, Europe 2 Department of Endocrinology, Hospital Clinic de Barcelona, Europe 3 Centro de Investigacion Biomèdica en Red de Diabetes y Enfermedades Metabolicas Asociadas (CIBERDEM), Barcelona, Europe 4 Department of Endocrinology, Endocrinology and Metabolism Unit, Europe Correspondence: Felice Strollo, Elle-Di, Endocrinology and Metabolism Unit, Europe, Tel +390 632 196 39, Email felix.strollo@gmail.com *AMD is the Italian acronym for the Association of Diabetes Specialists and OSDI is the Italian acronym for Diabetes Care Health Professionals Received: March 29, 2016 | Published: May 03, 2016 Abstract Lipodystrophy (LD) is still an ill-defined pathological entity, common to a series of diseases including diabetes. Lipohypertrophy (LH) is its most common expression and depends mostly on repeated needle trauma to the skin in insulin treated patients. This short review tries to clarify some clinically relevant points and stresses the need to put a stronger effort on patient education and health care training in order to prevent any life-threatening hypoglycemic events eventually related to miss LH identification in people with diabetes. Keywords: diabetes, lipodystrophy, terminology, methodology, lipohypertrophy, insulin-treated patients, trauma, low cultural level Journal of Diabetes, Metabolic Disorders & Control Mini Review Open Access