Cutaneous Adverse Effects from Diabetes Devices in Pediatric Patients with Type 1 Diabetes Mellitus: a Systematic Review (Preprint)

BACKGROUND Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSII) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance. OBJECTIVE This systematic review aims to explore the current literature surrounding dermatologic complications of CGM, CSII, and the impact on patient outcomes. METHODS A systematic review of the literature was carried out using PRISMA 2020 guidelines utilizing five online databases. Included articles were those containing primary data relevant to human subjects and adverse CGM and CSII devices in pediatric populations of which greater than 50% of the sample size were ages 0-21. Qualitative analysis was chosen due to the heterogeneity of outcomes. RESULTS Following the application of exclusion criteria, 25 studies were analyzed and discussed. The most common complication covered is contact dermatitis with 12 identified studies. 6 studies concern lipodystrophies, 4 cover nonspecific cutaneous changes, and the remaining 3 cover unique cutaneous findings such as granulomatous reactions and panniculitis. CONCLUSIONS The dermatologic complications of CGM and CSII pose a potential risk to long-term glycemic control in T1D, especially in young patients where skin lesions can lead to discontinuation. Increased manufacturer transparency is critical and further studies are needed to expand upon the current preventative measures such as device site rotation and steroid creams, which lack consistent effectiveness.