This prospective 1-yr study on a large cohort of Italian children and adolescents with type 1 diabetes using insulin pump therapy showed a low total failure rate, highlighting the importance of continuous education to reduce failures” Rabbone et al (2018).
AIMS: Incidence of insulin pump failures in a cohort of children and adolescents with type 1 diabetes was evaluated prospectively during a 1-yr follow-up.
MATERIALS AND METHODS: Insulin pump breakdown and infusion set failures were prospectively registered in a cohort of 1046 children and adolescents from 25 tertiary pediatric diabetes centers (50% males, mean age 12.2±4.1 yrs), with type 1 diabetes since 6.7±3.6 yrs, and using insulin pump since 3.3±2.2 yrs.
RESULTS: An average rate of 4.5 failures/person-years was registered; the incidence (events per person-year) for each failure was the following: 8.4 for hyperglycemia episodes solved with infusion set change; 7 for bubbles; 2.8 for kinking; 2.4 for bleeding; 2 for set dislodge; 2 for pump blockage; 1.9 for tunneling; 1.8 for lipohypertrophy; 0.3 for infection. At multivariate analysis significant association between HbA1c and lipohypertrophy (p < 0.0028) was shown. Analysis by age-group (<6, 6-11, >11 years) showed a higher frequency of bubbles, hyperglycemia episodes and lipohypertrophy in preschoolers; tunneling and pump blockage were more frequent in adolescents. Aspart was associated with a lower risk of bubbles and hyperglycemia whereas glulisine was associated with a higher risk of lipohypertrophy and pump blockage. The usage of oblique cannula was associated with a low risk of all failures except infections.
CONCLUSIONS: This prospective 1-yr study on a large cohort of Italian children and adolescents with type 1 diabetes using insulin pump therapy showed a low total failure rate, highlighting the importance of continuous education to reduce failures. Lipohypertrophy was the only issue associated with a worsening of metabolic control.
Rabbone, I., Minuto, N., Toni, S., Lombardo, F., Iafusco, D., Marigliano, M., Schiaffini, R., Maltoni, G., Frongia, A.P., Scardapane, M., Nicolucci, A., Cherubini, V., Bonfanti, R. and Scaramuzza, A.E. (2018) Insulin pump breakdown and infusion set failure in Italian children with type 1 diabetes: 1-year prospective observational study with suggestions to minimize clinical impact. Diabetes, Obesity & Metabolism. June 12th. .