Dermatological Complications of Insulin Therapy in Children with Type 1 Diabetes: Cross-Sectional Study

Background. Dermatological complications of insulin therapy in children with type 1 diabetes (T1D) cause low patient retention to treatment, reduce insulin therapy (with injection pens and pumps) efficiency, limit the use of modern high-tech methods of glycemia monitoring. Objective. Our aim was to study the structure and risk factors of dermatological complications of insulin therapy in children with T1D. Methods. Children aged from 1 to 17 with T1D and their parents were interviewed using the questionnaire containing 28 questions about skin changes associated with insulin therapy or glycemia monitoring in the past and about injection techniques. Skin (local allergic and/or inflammation reactions) and subcutaneous fat (hypotrophy and hypertrophy) changes at injection, infusion set, catheter and sensor sites were estimated via patient examination. The structure of dermatological complications of insulin therapy and their correlation with injection technique, infusion pump sets installation and glycemia monitoring were analyzed. Results. The study has included 50 patients with median age of 12 years (10; 14), T1D duration of 4 years (3; 7). 32 patients have performed insulin injections via injection pens, others have used insulin pump therapy. Continuous glycemia monitoring via sensor-augmented pump was performed in 5 patients, flash glycemia monitoring — in 17 patients. Allergic reactions (urticarial-type) to insulin were reported in 4 (8%) cases. Signs of allergic contact dermatitis at the catheter/sensor site were revealed in 5/18 (28%) patients on insulin pump therapy (no rotation of infusion systems installation sites) and 10/22 (45%) patients on glycemia monitoring (3 with continuous glycemia monitoring, 7 with flash glycemia monitoring). Lipoatrophy was revealed in 1 patient (on insulin pump therapy), lipohypertrophy was revealed in 22 patients: 20/32 (63%) were using injection pens and 2/18 (11%) — insulin pump therapy. Lipohypertrophy was revealed more often on self-administration via injection pens (in all cases patients did not change the insulin injection site, the needle was replaced less than 1 time per day). Conclusion. Risk of dermatological complications in children with T1D is higher when the injection technique or infusion set installation is inappropriate.

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