title: Clinical review: insulin pump-associated adverse events in adults and children.
abstract: OBJECTIVE
  Insulin pumps are a vital and rapidly developing tool in the treatment of type 1 diabetes mellitus in both adults and children. Many studies have highlighted outcomes and assessed their potential advantages, but much of the data on adverse outcomes are limited and often based on outdated technology. We aimed to review and summarize the available literature on insulin pump-associated adverse events in adults and children.
  
  
  METHODS
  A literature search was undertaken using PubMed, EMBASE, and the Cochrane library. Articles were then screened by title, followed by abstract, and full text as needed. A by-hand search of reference lists in identified papers was also utilised. All searches were limited to English language material, but no time limits were used.
  
  
  RESULTS
  Current and past literature regarding insulin pump-associated adverse events is discussed, including potential metabolic and non-metabolic adverse events, in particular: pump malfunction; infusion set/site issues; and cutaneous problems. We show that even with modern technology, adverse events are common, occurring in over 40 % of users per year, with a minority, particularly in children, requiring hospital management. Hyperglycaemia and ketosis are now the most common consequences of adverse events and are usually associated with infusion set failure. This differs from older technology where infected infusion sites predominated.
  
  
  CONCLUSIONS
  This timely review covers all potential insulin pump-associated adverse events, including their incidence, features, impacts, and contributory factors such as the pump user. The importance of ongoing anticipatory education and support for patients and families using this intensive insulin technology is highlighted, which if done well should improve the overall experience of pump therapy for users, and hopefully reduce the incidence and impact of severe adverse events.
authors.affiliation: Department of Women's and Children's Health, University of Otago, PO Box 913, Dunedin, 9054, New Zealand.
authors.forename: P L
authors.initials: PL
authors.lastname: Ross
authors.affiliation: Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: Milburn
authors.affiliation: Department of Women's and Children's Health, University of Otago, PO Box 913, Dunedin, 9054, New Zealand.
authors.forename: D M
authors.initials: DM
authors.lastname: Reith
authors.affiliation: Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand.
authors.forename: E
authors.initials: E
authors.lastname: Wiltshire
authors.affiliation: Department of Women's and Children's Health, University of Otago, PO Box 913, Dunedin, 9054, New Zealand. Ben.wheeler@otago.ac.nz.|Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand. Ben.wheeler@otago.ac.nz.|Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand. Ben.wheeler@otago.ac.nz.
authors.forename: B J
authors.initials: BJ
authors.lastname: Wheeler
mesh_terms: D000328:Adult; D002648:Child; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems / Q000009:adverse effects*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Adverse event; Continuous subcutaneous insulin infusion; Insulin pump; Type 1 diabetes