Insulin pump breakdown and infusion set failure in Italian children with type 1 diabetes: A 1-year prospective observational study with suggestions to minimize clinical impact

Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED)

Research output: Contribution to journalArticle

Abstract

AIM: To evaluate the incidence of insulin pump and infusion set failures in a cohort of children and adolescents with type 1 diabetes during a 1-year 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 centres (50% male, mean age 12.2 ± 4.1 years), with type 1 diabetes from the age of 6.7 ± 3.6 years, and using an insulin pump from the age of 3.3 ± 2.2 years.

RESULTS: An average rate of 4.5 failures/person-year was registered; the incidences (events per person-year) for each failure were 8.4 for hyperglycaemia 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 tunnelling, 1.8 for lipohypertrophy, and 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, hyperglycaemia episodes and lipohypertrophy in preschoolers; tunnelling and pump blockage were more frequent in adolescents. Aspart was associated with a lower risk of bubbles and hyperglycaemia 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-year 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.

Original languageEnglish
Pages (from-to)2551-2556
Number of pages6
JournalDiabetes, Obesity and Metabolism
Volume20
Issue number11
DOIs
Publication statusPublished - Nov 2018

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Infusion Pumps
Type 1 Diabetes Mellitus
Observational Studies
Hyperglycemia
Prospective Studies
Insulin
Incidence
Infection
Multivariate Analysis
Pediatrics
Hemorrhage
Education
Therapeutics

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Insulin pump breakdown and infusion set failure in Italian children with type 1 diabetes : A 1-year prospective observational study with suggestions to minimize clinical impact. / Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED).

In: Diabetes, Obesity and Metabolism, Vol. 20, No. 11, 11.2018, p. 2551-2556.

Research output: Contribution to journalArticle

Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED). / Insulin pump breakdown and infusion set failure in Italian children with type 1 diabetes : A 1-year prospective observational study with suggestions to minimize clinical impact. In: Diabetes, Obesity and Metabolism. 2018 ; Vol. 20, No. 11. pp. 2551-2556.
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title = "Insulin pump breakdown and infusion set failure in Italian children with type 1 diabetes: A 1-year prospective observational study with suggestions to minimize clinical impact",
abstract = "AIM: To evaluate the incidence of insulin pump and infusion set failures in a cohort of children and adolescents with type 1 diabetes during a 1-year 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 centres (50{\%} male, mean age 12.2 ± 4.1 years), with type 1 diabetes from the age of 6.7 ± 3.6 years, and using an insulin pump from the age of 3.3 ± 2.2 years.RESULTS: An average rate of 4.5 failures/person-year was registered; the incidences (events per person-year) for each failure were 8.4 for hyperglycaemia 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 tunnelling, 1.8 for lipohypertrophy, and 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, hyperglycaemia episodes and lipohypertrophy in preschoolers; tunnelling and pump blockage were more frequent in adolescents. Aspart was associated with a lower risk of bubbles and hyperglycaemia 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-year 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.",
author = "{Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED)} and Ivana Rabbone and Nicola Minuto and Sonia Toni and Fortunato Lombardo and Dario Iafusco and Marco Marigliano and Riccardo Schiaffini and Giulio Maltoni and Frongia, {Anna P} and Marco Scardapane and Antonio Nicolucci and Valentino Cherubini and Riccardo Bonfanti and Scaramuzza, {Andrea E}",
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T1 - Insulin pump breakdown and infusion set failure in Italian children with type 1 diabetes

T2 - A 1-year prospective observational study with suggestions to minimize clinical impact

AU - Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED)

AU - Rabbone, Ivana

AU - Minuto, Nicola

AU - Toni, Sonia

AU - Lombardo, Fortunato

AU - Iafusco, Dario

AU - Marigliano, Marco

AU - Schiaffini, Riccardo

AU - Maltoni, Giulio

AU - Frongia, Anna P

AU - Scardapane, Marco

AU - Nicolucci, Antonio

AU - Cherubini, Valentino

AU - Bonfanti, Riccardo

AU - Scaramuzza, Andrea E

N1 - © 2018 John Wiley & Sons Ltd.

PY - 2018/11

Y1 - 2018/11

N2 - AIM: To evaluate the incidence of insulin pump and infusion set failures in a cohort of children and adolescents with type 1 diabetes during a 1-year 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 centres (50% male, mean age 12.2 ± 4.1 years), with type 1 diabetes from the age of 6.7 ± 3.6 years, and using an insulin pump from the age of 3.3 ± 2.2 years.RESULTS: An average rate of 4.5 failures/person-year was registered; the incidences (events per person-year) for each failure were 8.4 for hyperglycaemia 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 tunnelling, 1.8 for lipohypertrophy, and 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, hyperglycaemia episodes and lipohypertrophy in preschoolers; tunnelling and pump blockage were more frequent in adolescents. Aspart was associated with a lower risk of bubbles and hyperglycaemia 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-year 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.

AB - AIM: To evaluate the incidence of insulin pump and infusion set failures in a cohort of children and adolescents with type 1 diabetes during a 1-year 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 centres (50% male, mean age 12.2 ± 4.1 years), with type 1 diabetes from the age of 6.7 ± 3.6 years, and using an insulin pump from the age of 3.3 ± 2.2 years.RESULTS: An average rate of 4.5 failures/person-year was registered; the incidences (events per person-year) for each failure were 8.4 for hyperglycaemia 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 tunnelling, 1.8 for lipohypertrophy, and 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, hyperglycaemia episodes and lipohypertrophy in preschoolers; tunnelling and pump blockage were more frequent in adolescents. Aspart was associated with a lower risk of bubbles and hyperglycaemia 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-year 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.

U2 - 10.1111/dom.13419

DO - 10.1111/dom.13419

M3 - Article

C2 - 29893044

VL - 20

SP - 2551

EP - 2556

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

SN - 1462-8902

IS - 11

ER -