Dermatological complications of insulin therapy in children with type 1 diabetes

Authors

  • Hilde E van Munster
  • Cathelijne PM van de Sande
  • Paul G Voorhoeve
  • Janiëlle AEM van Alfen-van der Velden

DOI:

https://doi.org/10.1002/edn.255

Keywords:

children, dermatological complications, diabetes mellitus type 1, insulin therapy

Abstract

Abstract

Dermatological complications at insulin administration sites, like lipohypertrophy, lipoatrophy and erythema, are common in children with type 1 diabetes. These complications can be painful, disfiguring and may influence glycaemic control. Studies on epidemiology and etiology are needed before prevention or treatment is possible.

The aim of this study is to determine the prevalence of common dermatological complications in children with type 1 diabetes and to assess associations between dermatological complications and possible risk factors.

In this cross-sectional study 231 children with type 1 diabetes were included. Dermatological complications were assessed and a questionnaire with possible risk factors was completed. Data were evaluated using χ2 tests.

The results showed that lipohypertrophy was present in 34.8% of the children, lipoatrophy in 8.1% and erythema in 24.6%. Lipohypertrophy was associated with multiple daily injection therapy (p=0.03) and insufficiencyof alternating administration sites (p<0.001). Lipoatrophy was not influenced by type of insulin therapy (p=0.44) but was found to be associated with less frequent injection site alternation in patients using multiple dailyinjections (p=0.01). Also, HbA1c level was positively associated with lipoatrophy (p=0.01). Erythema of the skin was more frequently diagnosed in children with continuous subcutaneous insulin pump therapy (p<0.001). A history of cutaneous infections and dry skin on exam day were independently associated with erythema atinsulin administration sites (p<0.001 and 0.04,respectively).

Dermatological complications are a common problem in children with type 1 diabetes making frequent examination of the skin in these children an important aspect of their medical care.

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References

Johansson UB, et al. Impaired absorption of insulin aspart from lipohypertrophic injection sites. Diabetes Care 2005;28:2025�7.

Young RJ, et al. Diabetic lipohypertrophy delays insulin absorption. Diabetes Care 1984;7:479�80.

Kordonouri O, et al. Lipohypertrophy in young patients with type 1 diabetes. Diabetes Care 2002;25:634.

Ahmed I, Goldstein B. Diabetes mellitus. Clin Dermatol 2006;24:237�46.

Milan G, et al. Lipoatrophy induced by subcutaneous insulin infusion: ultrastructural analysis and gene expression profiling. J Clin Endocrinol Metab 2010;95:3126�32.

Takatsuki H, et al. A case of insulin allergy: the crystalline human insulin may mask its antigenicity. Diabetes Res Clin Pract 1991;12:137�9.

Jermendy G, et al. �Lipoblastoma-like� lipoatrophy induced by human insulin: morphological evidence for local dedifferentiation of adipocytes? Diabetologia 2000;43:955�6.

Lopez X, et al. Human insulin analog-induced lipoatrophy. Diabetes Care 2008;31:442�4.

Swelheim HT, et al. Lipoatrophy in a girl with type 1 diabetes: beneficial effects of treatment with a glucocorticoid added to an insulin analog. Diabetes Care 2012;35:e22.

De Villiers FP. Lipohypertrophy � a complication of insulin injections. S Afr Med J 2005;95:858�9.

Pavlovic MD, et al. The prevalence of cutaneous manifestations in young patients with type 1 diabetes. Diabetes Care 2007;30:1964�7.

Conwell LS, et al. Dermatological complications of continuous subcutaneous insulin infusion in children and adolescents. J Pediatr 2008;152:622�8.

Schober E, Rami B. Dermatological side effects and complications of continuous subcutaneous insulin infusion in preschool-age and school-age children. Pediatr Diabetes 2009;10:198�201.

Omar MA, et al. Lipohypertrophy in children and adolescents with type 1 diabetes and the associated factors. BMC Res Notes 2011;4:290.

Vardar B, Kizilci S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract 2007;77:231�6.

Friedrichs A, et al. Injection force of reusable insulin pens: Novopen 4, Lilly Luxura, Berlipen, and ClikSTAR. J Diabetes Sci Technol 2011;5:1185�90.

Hemmingsen H, et al. A prefilled insulin pen with a novel injection mechanism and a lower injection force than other prefilled insulin pens. Diabetes Technol Ther 2011;13:1207�11.

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Published

2014-11-01

How to Cite

van Munster, H. E., PM van de Sande, C., Voorhoeve, P. G., & van Alfen-van der Velden, J. A. (2014). Dermatological complications of insulin therapy in children with type 1 diabetes. International Diabetes Nursing, 11(3), 79–84. https://doi.org/10.1002/edn.255

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Section

Research Article