title: Insulin Infusion Set Use: European Perspectives and Recommendations.
abstract: Insulin pump users worldwide depend on insulin infusion sets (IISs) for predictable delivery of insulin to the subcutaneous tissue. Yet emerging data indicates that IISs are associated with many pump-related adverse events and may contribute to potentially life-threatening problem of unexplained hyperglycemia. The relative scarcity of published research on IISs to date, the heterogeneity of regional IIS practices, and the increasing demand for international standards guiding their use prompted convening of a panel of diabetologists and diabetes nurse educators last February, in Milan, Italy, to discuss a framework for optimizing IIS practice in Europe. The multinational panel was tasked, first, with identifying the often-overlooked IIS issues that can affect patients' experience of pump therapy-e.g., partial or complete blockage of the cannula, skin pathologies, unpredictable variations in insulin absorption, dislodgment, and the demands of site rotation and set changes-and, second, with establishing direction for developing cohesive protocols to assure long-term success. As reported in this article, the panel examined IIS-related complications of pump therapy encountered in clinical practice, considered country-wide policies to prevent and mitigate such complications, and updated priorities for improving IIS education on issues of device selection, skin care, and troubleshooting unexplained hyperglycemia. These recommendations may be more relevant with the possibility of closed-loop systems available in the near future.
authors.affiliation: 1 Medicover Berlin-Mitte , Clinic for Endocrinology and Diabetology, Berlin, Germany .
authors.forename: Dorothee
authors.initials: D
authors.lastname: Deiss
authors.affiliation: 2 Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg , Gothenburg, Sweden .
authors.forename: Peter
authors.initials: P
authors.lastname: Adolfsson
authors.affiliation: 3 Diabetes Policlinic, Maasstad Hospital , Rotterdam, The Netherlands .
authors.forename: Marije
authors.initials: M
authors.lastname: Alkemade-van Zomeren
authors.affiliation: 4 Department of Medicine, Perugia University School of Medicine , Perugia, Italy .
authors.forename: Geremia B
authors.initials: GB
authors.lastname: Bolli
authors.affiliation: 5 Department of Diabetes and Endocrinology, Centre Hospitalier Sud-Francilien , Corbeil-Essonnes, France .
authors.forename: Guillaume
authors.initials: G
authors.lastname: Charpentier
authors.affiliation: 6 Department of Information Engineering, University of Padova , Padova, Italy .
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
authors.affiliation: 7 Diabetes Center for Children and Adolescents , Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany .
authors.forename: Thomas
authors.initials: T
authors.lastname: Danne
authors.affiliation: 8 Diabetes Care Unit, A.S.S.T. of Spedali Civili , Brescia, Italy .
authors.forename: Angela
authors.initials: A
authors.lastname: Girelli
authors.affiliation: 9 German Clinic for Diagnosis, Section for Pediatric Diabetes Therapy, DKD HELIOS Klinik , Weisbaden, Germany .
authors.forename: Heiko
authors.initials: H
authors.lastname: Mueller
authors.affiliation: 10 The Diabetes Education Group , Lakeville, CT, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Verderese
authors.affiliation: 11 Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital; Institute of Functional Genomics, UMR CNRS 5203/INSERM U1191, University of Montpellier , Montpellier, France .
authors.forename: Eric
authors.initials: E
authors.lastname: Renard
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005060:Europe; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Insulin infusion sets; artificial pancreas; insulin pumps; lipohypertrophy; unexplained hyperglycemia