Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Diabetes. May 15, 2026; 17(5): 114042
Published online May 15, 2026. doi: 10.4239/wjd.v17.i5.114042
Published online May 15, 2026. doi: 10.4239/wjd.v17.i5.114042
From lipodystrophy to subcutaneous insulin depots: Overlooked mechanisms of glycemic variability in patients with diabetes
Nhi Thi Y Nguyen, Hau Phuc Tran, Dat Xuan Nguyen, Duong Hung Tran, Phuong Ho Thi Hoai, University of Medicine and Pharmacy, Hue University, Hue 530000, Viet Nam
Thang Viet Luong, Hai Nguyen Ngoc Dang, Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Tasmania, Australia
Meng-Chi Lee, Department of Critical Care Medicine, Royal Hobart Hospital, Hobart 7000, Tasmania, Australia
Co-first authors: Nhi Thi Y Nguyen and Hau Phuc Tran.
Co-corresponding authors: Thang Viet Luong and Hai Nguyen Ngoc Dang.
Author contributions: Nguyen NTY conceptualized the study and prepared the original draft; Tran HP contributed to the literature search, evidence synthesis, and development of the manuscript; Luong TV provided guidance on the conceptual framework and critical intellectual input; Dang HNN ensured methodological consistency and coordinated communication with collaborators; Nguyen NTY, Tran HP, Luong TV, Nguyen DX, Tran DH, Hoai PHT, Lee MC, and Dang HNN contributed to reviewing and editing the manuscript and approved the final version. Nguyen NTY and Tran HP contributed equally to this work and are co-first authors. Luong TV and Dang HNN were designated as co-corresponding authors because of their supervisory roles.
AI contribution statement: We used ChatGPT solely as a tool for grammar checking and language polishing to improve the clarity and flow of the manuscript. No portion of the Main Text (Abstract, Introduction, Materials and Methods, Results, Discussion, and Conclusion) was AI-generated. The entire content and all original ideas were developed and written exclusively by the research team. The AI tool was used only for language polishing and stylistic improvements, sometimes for translation. It was not utilized for data analysis or any form of writing assistance. No AI tool participated in the design of the study or the interpretation of the research results. All figures in the manuscript were created using specialized professional software by the authors. We did not use AI to generate any Figures. All AI-generated outputs were critically reviewed and revised by the authors.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Corresponding author: Hai Nguyen Ngoc Dang, MD, Doctor, Menzies Institute for Medical Research, University of Tasmania, 1/17 Liverpool Street, Hobart 7000, Tasmania, Australia.
Received: September 10, 2025
Revised: March 10, 2026
Accepted: March 26, 2026
Published online: May 15, 2026
Processing time: 243 Days and 16.3 Hours
Revised: March 10, 2026
Accepted: March 26, 2026
Published online: May 15, 2026
Processing time: 243 Days and 16.3 Hours
Core Tip
Core Tip: Lipohypertrophy is a common but often overlooked cause of unstable insulin activity. Tissue hypertrophy and fibrosis at injection sites can create insulin depot behavior, leading to delayed and unpredictable absorption with both hyperglycemia and late hypoglycemia. A practical management pathway combines routine injection-site inspection with palpation (and ultrasound when needed), structured rotation and technique education, and close monitoring with individualized dose adjustment when patients are switched away from affected areas. Embedding injection-site care into routine insulin titration can reduce avoidable glycemic variability and improve insulin safety.