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Introduction and Objective: Besides injection site avoidance, there is no treatment for lipohypertrophy (LH), a common complication of insulin therapy associated with variable, impaired insulin absorption and suboptimal glycemic control. We investigated a tension offloading patch (embrace®, approved to reduce post-incisional scarring) in adults with T1DM and LH. Methods: Participants with T1DM ≥3 years, aged 18-65, and with ≥2 palpable abdominal LH lesions ≥3 cm in longest axis as confirmed by ultrasound were recruited in an exploratory single-arm intervention study. Participants self-applied the thin transparent adhesive patch (4.7 x 12 cm) every ~10 days over the target lesion for 16 weeks. Volumes of the target and a non-treated control lesion were assessed by ultrasound at baseline and weeks 8 and 16. Biopsies of target and control lesions were taken at week 16 for histological analysis in a blinded fashion. Results: Of 29 enrolled participants (mean±SD age 46±11 years, diabetes duration 27±10 years, HbA1c 7.3±0.6%, 4 female, 27 on multiple daily injection, 2 on pump), 27 completed the study. Participants’ average estimated age of both LH lesions was >5 years. Mean target lesion volume decreased from 15.08 mL at baseline to 13.64 mL at 8 weeks to 12.39 mL at 16 weeks (p<0.0001), while comparator lesion volume slightly increased by 0.336 mL (p=0.01). Histology showed less scar-like morphology (automated image analysis of Picrosirius Red staining, p=0.023) and less fat (Oil Red O staining, 6.97 average fold reduction, p=0.001) in target lesions. Out of 332 applications, 13 participants reported a total of 33 site reactions (9.9%), all graded as mild and quickly resolving with no resulting discontinuations. Conclusion: A tension offloading patch applied for 16 weeks was associated with a significant 18% decrease in volume of LH lesions and reduced fibrosis and fat on histology. RCTs are needed to fully assess this first candidate treatment for LH. Disclosure J. DeVries: Research Support; Neodyne, Gan & Lee Pharmaceuticals. Consultant; Gan & Lee Pharmaceuticals. Research Support; Liom. Advisory Panel; Liom. Speaker's Bureau; Novo Nordisk A/S. S. Famulla: Research Support; Neodyne Biosciences. M.S. Stoffel: Research Support; Neodyne Biosciences, Inc. J.L. Guo: Consultant; Neodyne Biosciences. H. Talbott: Consultant; Neodyne Biosciences Inc. L. Hirsch: Consultant; Boehringer-Ingelheim, Neodyne Biosciences, Inc. K.J. Lipman: Employee; Neodyne Biosciences, Inc. J. Jackson: None. Funding Neodyne Biosciences, Inc