Dermatological Complications of Continuous Subcutaneous Insulin Infusion in Children and Adolescents

Conwell, Louise S.; Pope, Elena; Artiles, Ana M.; Mohanta, Arun; Daneman, Alan; Daneman, Denis

doi:10.1016/j.jpeds.2007.10.006

« Previous Next »The Journal of Pediatrics
Volume 152, Issue 5 , Pages 622-628, May 2008

Dermatological Complications of Continuous Subcutaneous Insulin Infusion in Children and Adolescents

Louise S. Conwell, MBBS(Hons), PhD, FRACP
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Elena Pope, MD, FRCPC
- Division of Pediatric Medicine, Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Ana M. Artiles, RN, CDE
- Endocrine Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Arun Mohanta, RDMS
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Alan Daneman, MB, BCh, FRACR, FRCPC
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Denis Daneman, MB, BCh, FRCPC
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
- Reprint requests: Denis Daneman, MB, BCh, FRCPC, Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.

Received 25 April 2007; received in revised form 30 July 2007; accepted 4 October 2007. published online 21 January 2008.

Objectives

To describe the dermatological changes associated with continuous subcutaneous insulin infusion (CSII) therapy in youth with type 1 diabetes mellitus (T1D). To assess their association with duration of CSII, age, adiposity, HbA1_c, insulin dose, insulin brand, infusion set or site.

Study design

We conducted a cross-sectional study of 50 consecutive patients with T1D who were using CSII for >6 months (26 female; age, 13.3 ± 3.5 years [mean ± SD]; CSII duration, 2.8 ± 1.7 years; HbA1_c, 7.7% ± 1.1%). A grading scale was devised. Ultrasound scanning was performed in 8 subjects.

Results

The mean (±SD) severity score was 6.3 ± 3.5 (range, 0-14; maximum possible, 69). Most common were scars <3 mm diameter (94%), erythema not associated with nodules (66%), subcutaneous nodules (62%), and lipohypertrophy (42%). There was a significant negative correlation between severity score and body mass index z-score (r = −0.3, P = .039), but no correlation with HbA1_c, insulin brand or site. Infusion sets inserted at 90° were associated with lower scores (P = .03). Less than 5% of patients and parents considered stopping CSII because of skin concerns. Ultrasound scanning results of CSII sites revealed mild increased echogenicity of the dermis and hypodermis.

Conclusions

Dermatological changes were frequent, with increased severity associated with lower adiposity. These complications were not associated with glycemic control, nor did they prompt most to consider stopping CSII.

Abbreviations: BMI, Body mass index, CGMS, Continuous glucose monitoring system, CSII, Continuous subcutaneous insulin infusion, DKA, Diabetic ketoacidosis, T1D, Type 1 diabetes mellitus