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Cutaneous Adverse Effects From Diabetes Devices in Pediatric Patients With Type 1 Diabetes Mellitus: Systematic
Alicia Podwojniak1, Joseph Flemming1, Isabella J Tan2
1Rowan-Virtua School of Osteopathic Medicine, 113 Laurel Rd, Stratford, NJ, 08084, United States, 1 (856) 566-6789.
Insights
Dermatologic complications from continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs) can negatively impact type 1 diabetes (T1D) management in pediatric patients. Further research is needed to improve preventative strategies for these skin issues.
Area of Science:
- Endocrinology
- Dermatology
- Pediatrics
Background:
- Type 1 diabetes (T1D) management relies on continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs).
- Pediatric T1D patients are susceptible to dermatologic complications from these devices, potentially impairing glycemic control and treatment adherence.
- Common complications include contact dermatitis, lipodystrophies, and inflammatory lesions.
Approach:
- A systematic review adhering to PRISMA 2020 guidelines was conducted.
- Five online databases were searched for studies on adverse reactions to CGM and CSII in pediatric populations (ages 0-21).
- Qualitative analysis was employed due to outcome heterogeneity across 25 analyzed studies.
Key Points:
- Contact dermatitis was the most frequently reported complication (13 studies).
- Lipodystrophies (7 studies) and various other cutaneous changes were also documented.
- User acceptability and unique findings like granulomatous reactions were noted in fewer studies.
Conclusions:
- Dermatologic issues associated with CGM and CSII devices present a significant risk to long-term glycemic control in T1D, particularly in pediatric patients.
- Skin complications can lead to treatment discontinuation, highlighting the need for effective interventions.
- Enhanced manufacturer transparency and further research into preventative measures like site rotation and topical treatments are crucial.
Background:
Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance.
Objective:
This systematic review aims to explore the current literature surrounding dermatologic complications of CGM and CSII as well as the impact on patient outcomes.
Methods:
A systematic review of the literature was carried out using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines using 5 online databases. Included articles were those containing primary data relevant to human participants and adverse reactions to CGM and CSII devices in pediatric populations, of which greater than 50% of the sample size were aged 0-21 years. Qualitative analysis was chosen due to the heterogeneity of outcomes.
Results:
Following the application of exclusion criteria, 25 studies were analyzed and discussed. An additional 5 studies were identified after the initial search and inclusion. The most common complication covered is contact dermatitis, with 13 identified studies. Further, 7 studies concerned lipodystrophies, 5 covered nonspecific cutaneous changes, 3 covered unique cutaneous findings such as granulomatous reactions and panniculitis, and 2 discussed user acceptability.
Conclusions:
The dermatologic complications of CGM and CSII pose a potential risk to long-term glycemic control in T1D, especially in young patients where skin lesions can lead to discontinuation. Increased manufacturer transparency is critical and further studies are needed to expand upon the current preventative measures such as device site rotation and steroid creams, which lack consistent effectiveness.
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