title: Dermatological complications of continuous subcutaneous insulin infusion in children and adolescents.
abstract: OBJECTIVE
  To describe the dermatological changes associated with continuous subcutaneous insulin infusion (CSII) therapy in youth with type 1 diabetes mellitus (T1D). To assess their association with duration of CSII, age, adiposity, HbA1(c), insulin dose, insulin brand, infusion set or site.
  
  
  METHODS
  We conducted a cross-sectional study of 50 consecutive patients with T1D who were using CSII for >6 months (26 female; age, 13.3 +/- 3.5 years [mean +/- SD]; CSII duration, 2.8 +/- 1.7 years; HbA1(c), 7.7% +/- 1.1%). A grading scale was devised. Ultrasound scanning was performed in 8 subjects.
  
  
  RESULTS
  The mean (+/-SD) severity score was 6.3 +/- 3.5 (range, 0-14; maximum possible, 69). Most common were scars <3 mm diameter (94%), erythema not associated with nodules (66%), subcutaneous nodules (62%), and lipohypertrophy (42%). There was a significant negative correlation between severity score and body mass index z-score (r = -0.3, P = .039), but no correlation with HbA1(c), insulin brand or site. Infusion sets inserted at 90 degrees were associated with lower scores (P = .03). Less than 5% of patients and parents considered stopping CSII because of skin concerns. Ultrasound scanning results of CSII sites revealed mild increased echogenicity of the dermis and hypodermis.
  
  
  CONCLUSIONS
  Dermatological changes were frequent, with increased severity associated with lower adiposity. These complications were not associated with glycemic control, nor did they prompt most to consider stopping CSII.
authors.affiliation: Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Louise S
authors.initials: LS
authors.lastname: Conwell
authors.forename: Elena
authors.initials: E
authors.lastname: Pope
authors.forename: Ana M
authors.initials: AM
authors.lastname: Artiles
authors.forename: Arun
authors.initials: A
authors.lastname: Mohanta
authors.forename: Alan
authors.initials: A
authors.lastname: Daneman
authors.forename: Denis
authors.initials: D
authors.lastname: Daneman
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects*; D007332:Insulin Infusion Systems / Q000009:adverse effects*; D008297:Male; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D014463:Ultrasonography
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin