title: Duration of Infusion Set Survival in Lipohypertrophy Versus Nonlipohypertrophied Tissue in Patients with Type 1 Diabetes.
abstract: Improved insulin infusion set survival and faster insulin action are important issues for pump users and for the development of an artificial pancreas. The current recommendation is to change infusion sets every 3 days. Our objectives were to determine the effect of lipohypertrophy (LH) on infusion set survival and continuous glucose monitoring glucose levels.
  
  
  
  In this multicenter crossover trial, we recruited 20 subjects (age 28.1 ± 9.0 years) with type 1 diabetes (duration 17.5 ± 8.8 years) and an area of lipohypertrophied tissue >3 cm. Subjects alternated weekly wearing a Teflon infusion set in an area of either LH or non-LH for 4 weeks. Sets were changed after (a) failure or (b) surviving 7 days of use.
  
  
  
  The least-squares mean duration of infusion set survival for sets that lasted <7 days in lipohypertrophied tissue was 4.31 days compared with 4.12 days in nonlipohypertrophied tissue (P = 0.71). The average duration of set survival for individual subjects ranged from 2.2 to 7.0 days. Infusion sets in lipohypertrophied tissue failed due to hyperglycemia in 35% of subjects compared with 23% in nonlipohypertrophied tissue (P = 0.22). Both lipohypertrophied and nonlipohypertrophied tissues displayed a general increase in mean daily glucose after the third day of infusion set wear, but daily mean glucose did not differ by tissue type (P > 0.38 on each day).
  
  
  
  LH did not significantly affect infusion set survival or mean glucose. Achieving optimal infusion set performance requires research into factors affecting set survival. Additionally, the recommendation for duration of set change may need to be individualized.
authors.affiliation: 1 Barbara Davis Center for Childhood Diabetes, University of Colorado , Aurora, Colorado.|2 Georgetown University School of Medicine , Washington, District of Columbia.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Karlin
authors.affiliation: 3 Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine , Stanford, California.|4 School of Paediatrics and Child Health, The University of Western Australian , Perth, Western Australia.
authors.forename: Trang T
authors.initials: TT
authors.lastname: Ly
authors.affiliation: 5 Department of Pediatrics, University of Colorado , Aurora, Colorado.|6 Department of Biostatistics and Informatics, University of Colorado School of Public Health , Aurora, Colorado.
authors.forename: Laura
authors.initials: L
authors.lastname: Pyle
authors.affiliation: 1 Barbara Davis Center for Childhood Diabetes, University of Colorado , Aurora, Colorado.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Forlenza
authors.affiliation: 1 Barbara Davis Center for Childhood Diabetes, University of Colorado , Aurora, Colorado.
authors.forename: Laurel
authors.initials: L
authors.lastname: Messer
authors.affiliation: 1 Barbara Davis Center for Childhood Diabetes, University of Colorado , Aurora, Colorado.
authors.forename: R Paul
authors.initials: RP
authors.lastname: Wadwa
authors.affiliation: 3 Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine , Stanford, California.|7 Baylor College of Medicine, Department of Pediatrics, Houston, Texas.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: DeSalvo
authors.affiliation: 3 Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine , Stanford, California.
authors.forename: Sydney L
authors.initials: SL
authors.lastname: Payne
authors.affiliation: 3 Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine , Stanford, California.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hanes
authors.affiliation: 3 Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine , Stanford, California.
authors.forename: Paula
authors.initials: P
authors.lastname: Clinton
authors.affiliation: 1 Barbara Davis Center for Childhood Diabetes, University of Colorado , Aurora, Colorado.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: 3 Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Stanford University School of Medicine , Stanford, California.
authors.forename: Bruce
authors.initials: B
authors.lastname: Buckingham
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004868:Equipment Failure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D006984:Hypertrophy; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D001786:Blood Glucose