Frequency of Dermatological Side Effects of Continuous Subcutaneous Insulin Infusion in Children and Adolescents with Type 1 Diabetes

Background: The incidence of type 1 diabetes is rising, particularly in young infants. The treatment with continuous subcutaneous insulin infusion (CSII) offers certain benefits and has gained popularity. Insulin-pump therapy could be associated with cutaneous-adverse effects. The purpose of our study was to investigate the frequency and characterization of skin-related complications in patients with CSII. Methods: In a single center setting, 54 patients (28 male, 26 female) on CSII therapy aged between 3 and 20 years participated in our study. Data including duration of diabetes, duration of CSII, pump model, catheter material, frequency of catheter switch and hygiene procedures at time of puncture were collected through a standardized questionnaire and photographs of affected areas of the skin were made. Statistical analysis was done to verify an association with gender, patients age, HbA1c values, and body mass index. Results: Our observation revealed skin complications at the site of catheter insertion in 43 % (8 f, 15 m) of our patients. A frequent occurrence of scars (24 %, 6 f, 7 m), lipohypertrophic areas (20 %, 4 f, 7 m) and eczema (11 %, 1 f, 5 m) was observed. Furthermore, 6 % (1 f, 2 m) showed changes in pigmentation and 6 % (1 f, 2 m) lipoatrophy. The catheter localization had to be switched due to skin-complications in 24 % (6 f, 7 m) whereas none of our patients discontinued insulin-pump therapy. Conclusion: Skin-related complications during CSII are frequent and regular examination of the insertion sites is crucial. To verify the occurrence of lipoatrophy associated with insulin pump therapy - an otherwise rare complication - larger studies would be needed.