Endocrine Abstracts

Although the prevalence and aetiology of Dercum’s disease (Adiposis Dolorosa) are currently unknown, this condition is most commonly diagnosed between the ages of 35 and 50 years and more common in women than in men. We described the challenges of the glycaemic management of a 44-year-old male who was diagnosed with Dercum’s disease about a decade after the diagnosis of Type 1 Diabetes Mellitus. Despite previous episodes of diabetic ketoacidosis, his Hba1c over the last five year has been reasonable on once daily degludec and pre-prandial aspart. He has neither microvascular nor macrovascular complications to date. According to him, multiple nodules started to appear throughout his body, particularly in the abdominal region about five years ago but the lipomas had only become painful several months after their appearance. The patient found it increasingly difficult to manage his insulin injections due to the numerous painful nodules especially in the abdominal region due to the limited sites for insulin injection. Consequently, he has undergone multiple surgical excisions of lipomas, primarily for pain management and to facilitate insulin injections. Despite these interventions, the lipomas have recurred, necessitating repeated surgeries. The histologies confirmed the presence of lipomas. This case highlights several challenges faced by people with Type 1 Diabetes Mellitus and Dercum’s disease. In our case, he has limited sites for insulin administration due to extensive painful lipomas. He required multiple surgical resections for removal of the painful lipomas. This is complicated by the recurrence of lipomas at the resection sites. Other related comorbidities and its proposed management will be discussed. Clinical expertise from multidisciplinary team consisting of the diabetologist, diabetes nurse specialist, dermatologist, plastic surgeon, pain specialist and psychologist, is needed for optimal management of this complex case.