Skin Problems due to Treatment with Diabetes Technology: A Narrative Review
Main Article Content
Anna Korsgaard Berg
http://orcid.org/0000-0002-1260-0615
Claus Zachariae
http://orcid.org/0000-0001-5506-1319
Kirsten Nørgaard
http://orcid.org/0000-0003-1620-8271
Jannet Svensson
http://orcid.org/0000-0002-9365-0728
http://orcid.org/0000-0002-1260-0615
Claus Zachariae
http://orcid.org/0000-0001-5506-1319
Kirsten Nørgaard
http://orcid.org/0000-0003-1620-8271
Jannet Svensson
http://orcid.org/0000-0002-9365-0728
Abstract
Diabetes devices, such as insulin pumps, glucose sensors, and integrated automated insulin delivery systems, have brought about a transformative impact on the management of diabetes. This impact has been particularly significant for individuals with type 1 diabetes and increasingly for those with type 2 diabetes. These devices are designed for continuous wear, necessitating the consistent use of infusion sets, patch pumps, or glucose sensors that are inserted into the skin.
Regrettably, numerous studies have highlighted that skin-related issues stemming from diabetes devices are rather common. These problems encompass various forms of skin injury, allergic and irritative contact dermatitis, itching, wound formation, scarring, and lipodystrophies. The utilization of diabetes devices, both in the present and the foreseeable future, faces significant challenges due to these skin complications, but preventive strategies exist for especially skin injuries including use of a skin care regimen or patches. These challenges culminate not only in the discontinuation of device usage but also in decrease in quality of life and heavier disease burden.
This narrative literature review comprehensively synthesizes existing knowledge about skin problems triggered by diabetes devices, encompassing children, adolescents, and adults. The review delves into definitions, underlying causes, prevention strategies, and treatment approaches. Finally, the review provides recommendations for future research directions in skin problems and suggestions for advancement of in the part of diabetes devices in close contact with the skin to reduce device-related skin problems.
Article Details
How to Cite
BERG, Anna Korsgaard et al.
Skin Problems due to Treatment with Diabetes Technology: A Narrative Review.
Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4747>. Date accessed: 16 may 2024.
doi: https://doi.org/10.18103/mra.v11i11.4747.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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5. Sherr JL, Schoelwer M, Dos Santos TJ, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Insulin delivery. Pediatr Diabetes. n/a(n/a). doi:10.1111/pedi.13421
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7. Nørgaard K, Ranjan AG, Laugesen C, et al. Glucose Monitoring Metrics in Individuals With Type 1 Diabetes Using Different Treatment Modalities: A Real-World Observational Study. Diabetes Care. Published online August 23, 2023:dc231137. doi:10.2337/dc23-1137
8. Hartsough EM, Hylwa SA. Wearable Woes: Allergens in Diabetic Devices. Dermat Contact Atopic Occup Drug. 2021;32(1):19-31. doi:10.1097/DER.0000000000000673
9. Jedlowski PM, Te CH, Segal RJ, Fazel MT. Cutaneous Adverse Effects of Diabetes Mellitus Medications and Medical Devices: A Review. Am J Clin Dermatol. Published online October 25, 2018. doi:10.1007/s40257-018-0400-7
10. Cameli N, Silvestri M, Mariano M, Messina C, Nisticò SP, Cristaudo A. Allergic Contact Dermatitis, an Important Skin Reaction in Diabetes Device Users: A Systematic Review. Dermatitis. 2022;Publish Ahead of Print. doi:10.1097/DER.0000000000000861
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15. Berg AK, Olsen BS, Thyssen JP, et al. High frequencies of dermatological complications in children using insulin pumps or sensors. Pediatr Diabetes. 2018;19(4):733-740. doi:10.1111/pedi.12652
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17. Jick SS, Oleske DM, Persson R, Zamudio J, Facheris MF. Epidemiology of skin event rates among users of pumps for the subcutaneous administration of drugs for chronic conditions. Curr Med Res Opin. 2021;37(9):1563-1571. doi:10.1080/03007995.2021.1953971
18. Passanisi S, Salzano G, Lombardo F. Skin Involvement in Paediatric Patients with Type 1 Diabetes. Curr Diabetes Rev. 2022;18(4):46-55. doi:10.2174/1573399817666210903153837
19. Pavlović MD, Milenković T, Dinić M, et al. The prevalence of cutaneous manifestations in young patients with type 1 diabetes. Diabetes Care. 2007;30(8):1964-1967. doi:10.2337/dc07-0267
20. Berg AK, Grauslund AC, Nørgaard K, et al. Similar Skin Barrier Function in Persons with Type 1 Diabetes Compared with Healthy Controls. JID Innov. 2023;3(4). doi:10.1016/j.xjidi.2023.100200
21. Elias PM. Skin barrier function. Curr Allergy Asthma Rep. 2008;8(4):299-305. doi:10.1007/s11882-008-0048-0
22. Novak-Bilić G, Vučić M, Japundžić I, Meštrović-Štefekov J, Stanić-Duktaj S, Lugović-Mihić L. IRRITANT AND ALLERGIC CONTACT DERMATITIS - SKIN LESION CHARACTERISTICS. Acta Clin Croat. 2018;57(4):713-720. doi:10.20471/acc.2018.57.04.13
23. Ahrensbøll‐Friis U, Simonsen AB, Zachariae C, Thyssen JP, Johansen JD. Contact dermatitis caused by glucose sensors, insulin pumps, and tapes: Results from a 5-year period. Contact Dermatitis. 2020;n/a(n/a). doi:10.1111/cod.13664
24. Al Hayek AA, Robert AA, Al Dawish MA. Skin-Related Complications Among Adolescents With Type 1 Diabetes Using Insulin Pump Therapy. Clin Med Insights Endocrinol Diabetes. 2018;11:1179551418798794. doi:10.1177/1179551418798794
25. Rigo RS, Levin LE, Belsito DV, Garzon MC, Gandica R, Williams KM. Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes Mellitus. J Diabetes Sci Technol. Published online May 9, 2020:1932296820918894. doi:10.1177/1932296820918894
26. Herman A, Montjoye L de, Baeck M. Adverse cutaneous reaction to diabetic glucose sensors and insulin pumps: Irritant contact dermatitis or allergic contact dermatitis? Contact Dermatitis. 2020;83(1):25-30. doi:10.1111/cod.13529
27. Pyl J, Dendooven E, Van Eekelen I, et al. Prevalence and Prevention of Contact Dermatitis Caused by FreeStyle Libre: A Monocentric Experience. Diabetes Care. Published online February 13, 2020:dc191354. doi:10.2337/dc19-1354
28. Vidal-Albareda C, Yelmo-Valverde R, Solórzano-Zepeda C, Rodríguez-Muñoz N, de-la-Hoz-Caballer B, González-de-Olano D. Prevalence of contact dermatitis to glucose sensors in pediatric population and the main allergens involved. Contact Dermatitis. 2020;83(1):47-49. doi:10.1111/cod.13511
29. Kalus A, Shinohara MM, Wang R, et al. Evaluation of Insulin Pump Infusion Sites in Type 1 Diabetes: The DERMIS Study. Diabetes Care. 2023;46(9):1626-1632. doi:10.2337/dc23-0426
30. Schober E, Rami B. Dermatological side effects and complications of continuous subcutaneous insulin infusion in preschool-age and school-age children. Pediatr Diabetes. 2009;10(3):198-201. doi:10.1111/j.1399-5448.2008.00477.x
31. Nowakowska M, Jarosz-Chobot P, Polańska J, Machnica Ł. Bacterial strains colonizing subcutaneous catheters of personal insulin pumps. Pol J Microbiol. 2007;56(4):239-243.
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34. Patel B, Priefer R. Infections associated with diabetic-care devices. Diabetes Metab Syndr Clin Res Rev. 2021;15(2):519-524. doi:10.1016/j.dsx.2021.02.023
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38. Kordonouri O, Biester T, Schnell K, et al. Lipoatrophy in children with type 1 diabetes: an increasing incidence? J Diabetes Sci Technol. 2015;9(2):206-208. doi:10.1177/1932296814558348
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2. Libman I, Haynes A, Lyons S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2022;23(8):1160-1174. doi:10.1111/pedi.13454
3. Cengiz E, Danne T, Ahmad T, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1277-1296. doi:10.1111/pedi.13442
4. American Diabetes Association Professional Practice Committee, Draznin B, Aroda VR, et al. 7. Diabetes Technology: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S97-S112. doi:10.2337/dc22-S007
5. Sherr JL, Schoelwer M, Dos Santos TJ, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Insulin delivery. Pediatr Diabetes. n/a(n/a). doi:10.1111/pedi.13421
6. Tauschmann M, Forlenza G, Hood K, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Glucose monitoring. Pediatr Diabetes. 2022;23(8):1390-1405. doi:10.1111/pedi.13451
7. Nørgaard K, Ranjan AG, Laugesen C, et al. Glucose Monitoring Metrics in Individuals With Type 1 Diabetes Using Different Treatment Modalities: A Real-World Observational Study. Diabetes Care. Published online August 23, 2023:dc231137. doi:10.2337/dc23-1137
8. Hartsough EM, Hylwa SA. Wearable Woes: Allergens in Diabetic Devices. Dermat Contact Atopic Occup Drug. 2021;32(1):19-31. doi:10.1097/DER.0000000000000673
9. Jedlowski PM, Te CH, Segal RJ, Fazel MT. Cutaneous Adverse Effects of Diabetes Mellitus Medications and Medical Devices: A Review. Am J Clin Dermatol. Published online October 25, 2018. doi:10.1007/s40257-018-0400-7
10. Cameli N, Silvestri M, Mariano M, Messina C, Nisticò SP, Cristaudo A. Allergic Contact Dermatitis, an Important Skin Reaction in Diabetes Device Users: A Systematic Review. Dermatitis. 2022;Publish Ahead of Print. doi:10.1097/DER.0000000000000861
11. Burgmann J, Biester T, Grothaus J, Kordonouri O, Ott H. Pediatric diabetes and skin disease (PeDiSkin): A cross-sectional study in 369 children, adolescents and young adults with type 1 diabetes. Pediatr Diabetes. n/a(n/a). doi:10.1111/pedi.13130
12. Berg AK, Grauslund AC, Sørensen F, et al. A Skin Care Program to Prevent Skin Problems due to Diabetes Devices in Children and Adolescents: A Cluster-Controlled Intervention Study. Diabetes Care. Published online July 21, 2023:dc230462. doi:10.2337/dc23-0462
13. Alves da Silva C, Bregnhøj A, Mowitz M, Bruze M, Andersen KE, Sommerlund M. Contact dermatitis in children caused by diabetes devices. Contact Dermatitis. 2022;87(5):406-413. doi:10.1111/cod.14166
14. Berg AK, Simonsen AB, Svensson J. Perception and Possible Causes of Skin Problems to Insulin Pump and Glucose Sensor: Results from Pediatric Focus Groups. Diabetes Technol Ther. 2018;20(8):566-570. doi:10.1089/dia.2018.0089
15. Berg AK, Olsen BS, Thyssen JP, et al. High frequencies of dermatological complications in children using insulin pumps or sensors. Pediatr Diabetes. 2018;19(4):733-740. doi:10.1111/pedi.12652
16. Berg AK, Nørgaard K, Thyssen JP, et al. Skin Problems Associated with Insulin Pumps and Sensors in Adults with Type 1 Diabetes: A Cross-Sectional Study. Diabetes Technol Ther. 2018;20(7):475-482. doi:10.1089/dia.2018.0088
17. Jick SS, Oleske DM, Persson R, Zamudio J, Facheris MF. Epidemiology of skin event rates among users of pumps for the subcutaneous administration of drugs for chronic conditions. Curr Med Res Opin. 2021;37(9):1563-1571. doi:10.1080/03007995.2021.1953971
18. Passanisi S, Salzano G, Lombardo F. Skin Involvement in Paediatric Patients with Type 1 Diabetes. Curr Diabetes Rev. 2022;18(4):46-55. doi:10.2174/1573399817666210903153837
19. Pavlović MD, Milenković T, Dinić M, et al. The prevalence of cutaneous manifestations in young patients with type 1 diabetes. Diabetes Care. 2007;30(8):1964-1967. doi:10.2337/dc07-0267
20. Berg AK, Grauslund AC, Nørgaard K, et al. Similar Skin Barrier Function in Persons with Type 1 Diabetes Compared with Healthy Controls. JID Innov. 2023;3(4). doi:10.1016/j.xjidi.2023.100200
21. Elias PM. Skin barrier function. Curr Allergy Asthma Rep. 2008;8(4):299-305. doi:10.1007/s11882-008-0048-0
22. Novak-Bilić G, Vučić M, Japundžić I, Meštrović-Štefekov J, Stanić-Duktaj S, Lugović-Mihić L. IRRITANT AND ALLERGIC CONTACT DERMATITIS - SKIN LESION CHARACTERISTICS. Acta Clin Croat. 2018;57(4):713-720. doi:10.20471/acc.2018.57.04.13
23. Ahrensbøll‐Friis U, Simonsen AB, Zachariae C, Thyssen JP, Johansen JD. Contact dermatitis caused by glucose sensors, insulin pumps, and tapes: Results from a 5-year period. Contact Dermatitis. 2020;n/a(n/a). doi:10.1111/cod.13664
24. Al Hayek AA, Robert AA, Al Dawish MA. Skin-Related Complications Among Adolescents With Type 1 Diabetes Using Insulin Pump Therapy. Clin Med Insights Endocrinol Diabetes. 2018;11:1179551418798794. doi:10.1177/1179551418798794
25. Rigo RS, Levin LE, Belsito DV, Garzon MC, Gandica R, Williams KM. Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes Mellitus. J Diabetes Sci Technol. Published online May 9, 2020:1932296820918894. doi:10.1177/1932296820918894
26. Herman A, Montjoye L de, Baeck M. Adverse cutaneous reaction to diabetic glucose sensors and insulin pumps: Irritant contact dermatitis or allergic contact dermatitis? Contact Dermatitis. 2020;83(1):25-30. doi:10.1111/cod.13529
27. Pyl J, Dendooven E, Van Eekelen I, et al. Prevalence and Prevention of Contact Dermatitis Caused by FreeStyle Libre: A Monocentric Experience. Diabetes Care. Published online February 13, 2020:dc191354. doi:10.2337/dc19-1354
28. Vidal-Albareda C, Yelmo-Valverde R, Solórzano-Zepeda C, Rodríguez-Muñoz N, de-la-Hoz-Caballer B, González-de-Olano D. Prevalence of contact dermatitis to glucose sensors in pediatric population and the main allergens involved. Contact Dermatitis. 2020;83(1):47-49. doi:10.1111/cod.13511
29. Kalus A, Shinohara MM, Wang R, et al. Evaluation of Insulin Pump Infusion Sites in Type 1 Diabetes: The DERMIS Study. Diabetes Care. 2023;46(9):1626-1632. doi:10.2337/dc23-0426
30. Schober E, Rami B. Dermatological side effects and complications of continuous subcutaneous insulin infusion in preschool-age and school-age children. Pediatr Diabetes. 2009;10(3):198-201. doi:10.1111/j.1399-5448.2008.00477.x
31. Nowakowska M, Jarosz-Chobot P, Polańska J, Machnica Ł. Bacterial strains colonizing subcutaneous catheters of personal insulin pumps. Pol J Microbiol. 2007;56(4):239-243.
32. Lee HJ, Kim M. Skin Barrier Function and the Microbiome. Int J Mol Sci. 2022;23(21):13071. doi:10.3390/ijms232113071
33. McNichol L, Lund C, Rosen T, Gray M. Medical adhesives and patient safety: state of the science: consensus statements for the assessment, prevention, and treatment of adhesive-related skin injuries. J Wound Ostomy Cont Nurs Off Publ Wound Ostomy Cont Nurses Soc. 2013;40(4):365-380; quiz E1-2. doi:10.1097/WON.0b013e3182995516
34. Patel B, Priefer R. Infections associated with diabetic-care devices. Diabetes Metab Syndr Clin Res Rev. 2021;15(2):519-524. doi:10.1016/j.dsx.2021.02.023
35. Gentile S, Strollo F, Ceriello A, et al. Lipodystrophy in Insulin-Treated Subjects and Other Injection-Site Skin Reactions: Are We Sure Everything is Clear? Diabetes Ther. 2016;7(3):401-409. doi:10.1007/s13300-016-0187-6
36. 36. Tian T, Aaron RE, Huang J, et al. Lipohypertrophy and Insulin: An Update From the Diabetes Technology Society. J Diabetes Sci Technol. Published online August 9, 2023:19322968231187660. doi:10.1177/19322968231187661
37. Xatzipsalti M, Alvertis H, Kourousi G, et al. Lipoatrophy, a rare complication of diabetes: a single-center experience. Horm Athens Greece. Published online October 21, 2021. doi:10.1007/s42000-021-00324-z
38. Kordonouri O, Biester T, Schnell K, et al. Lipoatrophy in children with type 1 diabetes: an increasing incidence? J Diabetes Sci Technol. 2015;9(2):206-208. doi:10.1177/1932296814558348
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