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Stakeholder perspectives on managing insulin pump-related skin complications in children with type 1 diabetes: a
Ting Yuan1, Meiying Gao2, Chuhao Zhang1
1Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents' Health and Diseases, Hangzhou, China.
Background:
Insulin pump-related skin complications are common in children with type 1 diabetes, yet stakeholder perspectives and management practices remain poorly characterized. We aimed to investigate knowledge, attitudes, practices, and educational needs related to these complications among caregivers, healthcare professionals, and manufacturer technical support staff in China.
Methods:
This sequential explanatory mixed methods study included a cross-sectional, questionnaire-based survey (n=951) and semi-structured interviews (n=40). Quantitative data were analyzed descriptively, and qualitative data were analyzed using framework analysis. The quantitative and qualitative findings were integrated through triangulation.
Results:
Among 510 children represented by caregivers, 42.0% were reported to have experienced skin complications. Despite widespread concern, knowledge gaps persisted, particularly regarding infection management, and a knowledge-practice gap was evident. Qualitative findings identified role ambiguity as a structural barrier, with no stakeholder group assuming clear ownership of skin management. Participants described management as largely empirical and lacking standardized protocols. More than 96% of healthcare professionals and manufacturer technical support staff agreed that children and caregivers should receive comprehensive skin management training before pump initiation.
Conclusions:
Based on self-reported data, this descriptive study suggests that insulin pump-related skin complications were common among Chinese children with type 1 diabetes. Four hypothesis-generating challenges for skin management were identified, including knowledge-practice gaps, role ambiguity, empirical management, and insufficient training. They point to directions for future research such as developing evidence-based guidelines, clarifying interdisciplinary roles, and developing/implementing longitudinal education programs.
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