Ultrasonographic Measurement of Skin and Subcutaneous Thickness at Insulin Injection Sites among Adult Filipinos with Diabetes

Irene Catambing, Michael Villa

Abstract

Objectives. To determine the skin and subcutaneous thickness of adult diabetic Filipinos using ultrasonography.

Methodology. We studied 293 Filipino diabetic adults who had ultrasonographic measurements of their skin thickness (ST) and subcutaneous thickness (SCT) at common insulin injection sites.

 

Results. The mean ST ranges from 1.76 mm to 2.75mm. The mean SCT ranges from 6.91 mm to 19.1 mm. The anterior thigh area has the thinnest mean ST and SCT. On the other hand, the buttocks have the thickest mean ST and area of abdomen has the thickest mean SCT.

 

On multiple regression analysis, the predictors for skin thickness are injection site, age, BMI, gender and insulin use, however the overall influence of all these factors on skin thickness is variable at best.

 

Conclusion.  Skin thickness among Filipinos varies marginally depending on injection site being thickest at the buttocks and thinnest at the thighs. On the other hand, there is greater variability in SCT depending on the injection site, being thickest at the abdominal area and thinnest at the anterior thigh.

Full Text:

Abstract HTML PDF

References

Strauss K, Insulin injection techniques. Report from the 1st international insulin injection technique workshop. Practical Diabetes International. 2005;15(6)181-184.

Gibney M, Arce A, Byron K, Hirsch L. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: Implication for needle length recommendations. Current Medical Research & Opinion.2010; 26(6):1519-1530

Lo Presti D, Ingegnosi C, Strauss K. Skin and subcutaneous thickness at injecting sites in children with diabetes: Ultrasound findings and recommendations for giving injection. Pediatr Diabetes 2012;13: 525–533. doi: 10.1111/j.1399-5448.2012.00865.

Siminerio L, Kulkarni K, Meece J, Cypresse M. Strategies for insulin injection therapy in diabetes self management. American Association of Diabetes Educators. 2011/ http://www.diabeteseducator.org/ export/sites/aade/_resources.

Hansen B. Evidence based clinical guidelines for injection of insulin for adults with diabetes mellitus. Danish Nurses Organization. 2006. http://www.dsr.dk/Artikler/Documents/English/Evidence based_clinical_guidelines_for_injection.

Gniadecka M, et al. Skin ultrasonography – Clinical implications and experimental applications. The Gulf Journal of Dermatology. 1995;2(2):27-31.

Tan CY. Skin thickness measurement by pulsed ultrasound: its reproducibility, validation and variability. British Journal of Dermatology. 1982; 106, 657-667.

Waller Jeanette. Age and skin structure and function, a quantitative approach: Blood flow, ph, thickness and ultrasound echogenicity. Skin Research and Technology 2005; 11: 227-235

Frid A, Hirsch L, Gaspar D, Kreugel G. New injection recommendation for patients with diabetes. Diabetes and Metabolism. 2010;36:S3-S1.

Laurent A, et al. Echographic measurement of skin thickness in adults by high frequency ultrasound to assess the appropriate microneedle length for intradermal delivery of vaccines. Vaccine. 2007;25(34):6423-30.

Lee Y and Hwang K. Skin thickness of Korean adults. Surgical Radiology Anatomy. Springer Verlag. 2002;24(3-4):183-9.