title: Nonmetabolic complications of continuous subcutaneous insulin infusion: a patient survey.
abstract: BACKGROUND
  Little is known about the frequencies and types of nonmetabolic complications occurring in type 1 diabetes patients being treated by modern insulin pump therapy (continuous subcutaneous insulin infusion [CSII]), when recorded by standardized questionnaire rather than clinical experience.
  
  
  METHODS
  A self-report questionnaire was completed by successive subjects with type 1 diabetes attending an insulin pump clinic, and those with a duration of CSII of ≥6 months were selected for analysis (n=92). Questions included pump manufacturer, insulin, infusion set type and duration of use, frequency of infusion set and site problems, pump malfunctions, and patient-related problems such as weight change since starting CSII.
  
  
  RESULTS
  Median (range) duration of CSII was 3.3 (0.5-32.0) years, and mean ± SD duration of infusion set use was 3.2 ± 0.7 (range 2-6) days. The commonest infusion set problems were kinking (64.1% of subjects) and blockage (54.3%). Blockage was associated with >3 days of use of infusion sets plus lispro insulin in the pump (relative risk [95% confidence interval], 1.71 [1.03-2.85]; P=0.07). The commonest infusion site problem was lipohypertrophy (26.1%), which occurred more often in those with long duration of CSII (4.8 [2.38-9.45] vs. 3.0 [1.50-4.25] years; P=0.01). Pump malfunction had occurred in 48% of subjects (43% in the first year of CSII), with "no delivery," keypad, and battery problems commonly occurring. Although some patients reported weight gain (34%) and some weight loss (15%) on CSII, most patients (51%) reported no change in weight.
  
  
  CONCLUSIONS
  Pump, infusion set, and infusion site problems remain common with CSII, even with contemporary technology.
authors.affiliation: 1 Diabetes Research Group, King's College London School of Medicine , Guy's Hospital, London, United Kingdom .
authors.forename: John C
authors.initials: JC
authors.lastname: Pickup
authors.forename: Nardos
authors.initials: N
authors.lastname: Yemane
authors.forename: Anna
authors.initials: A
authors.lastname: Brackenridge
authors.forename: Siobhan
authors.initials: S
authors.lastname: Pender
mesh_terms: D000273:Adipose Tissue / Q000293:injuries* / Q000473:pathology; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006984:Hypertrophy / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007279:Injections, Subcutaneous / Q000009:adverse effects*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects*; D007332:Insulin Infusion Systems / Q000009:adverse effects*; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin