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

Ivana Rabbone, N Minuto, Sonia Toni, F Lombardo, Dario Iafusco, Marco Marigliano, R Schiaffini, Giulio Maltoni, AP Frongia, M Scardapane, A Nicolucci, Valentino Cherubini, R Bonfanti, Andrea E Scaramuzza, the Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED)

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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 (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. © 2018 John Wiley & Sons Ltd.
Original languageEnglish
Pages (from-to)2551-2556
Number of pages6
JournalDiabetes, Obesity and Metabolism
Volume20
Issue number11
DOIs
Publication statusPublished - 2018

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Rabbone, I., Minuto, N., Toni, S., Lombardo, F., Iafusco, D., Marigliano, M., Schiaffini, R., Maltoni, G., Frongia, AP., Scardapane, M., Nicolucci, A., Cherubini, V., Bonfanti, R., Scaramuzza, A. E., & (ISPED), T. D. S. G. O. T. I. S. O. P. E. A. D. (2018). 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, Obesity and Metabolism, 20(11), 2551-2556. https://doi.org/10.1111/dom.13419