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Ultrasound Detected Subcutaneous Changes in a Pediatric Cohort After Initiation of a New Insulin Pump or Glucose

Fiona M W Sørensen1,2, Jannet Svensson1,2, Christina Kinnander3

  • 1Diabetes Technology, Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark.

Diabetes Technology & Therapeutics
|June 6, 2023
PubMed

Insights

Subcutaneous tissue changes occurred at insulin infusion and glucose monitoring sites in children and adolescents. These changes, particularly at insulin sites, increased over time but did not correlate with HbA1c levels.

Area of Science:

  • Pediatric Endocrinology
  • Medical Ultrasound
  • Diabetes Technology

Background:

  • Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) are vital for managing type 1 diabetes in pediatric populations.
  • Understanding the impact of these devices on subcutaneous tissue is crucial for optimizing device performance and patient outcomes.
  • Previous research has not fully elucidated the longitudinal changes in subcutaneous tissue at CSII and CGM sites and their association with glycemic control.

Purpose of the Study:

  • To investigate subcutaneous tissue alterations at CSII and CGM device sites in children and adolescents.
  • To determine if these tissue changes correlate with glycated hemoglobin (HbA1c) levels.
  • To assess the depth of device insertion relative to subcutaneous tissue and muscle fascia.

Main Methods:

  • A prospective study involving 161 children and adolescents using CSII or CGM devices.
  • Ultrasound imaging was employed to evaluate subcutaneous tissue characteristics, including echogenicity, vascularization, and skin-to-muscle distance.
  • Data were collected during the first year of device use, with analyses considering age, BMI z-score, and sex.

Main Results:

  • Subcutaneous tissue depth varied significantly, with many devices inserted deeper than the mean distance, particularly in boys and younger children.
  • Hyperechogenicity was observed in 4.3% of CGM sites after 12 months.
  • Subcutaneous hyperechogenicity and vascularization at CSII sites increased significantly over time (41.2% to 69.3% and 2% to 16%, respectively), but not at CGM sites.
  • Hyperechogenicity was not found to be a predictor of elevated HbA1c.

Conclusions:

  • There is substantial variability in subcutaneous tissue depth, with diabetes devices often inserted deeply.
  • CSII sites showed a significant increase in hyperechogenicity and vascularization over time, unlike CGM sites.
  • The clinical significance of subcutaneous hyperechogenicity for insulin absorption remains uncertain, necessitating further research.

Keywords:
Continuous glucose monitoringContinuous subcutaneous insulin infusionPediatricSubcutisType 1 diabetesUltrasound

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