Skin problems affect children who use technology to treat diabetes

The continuous use of technologies such as glucose sensors and insulin pumps has made skin problems common in children and adolescents with diabetes, especially type 1. This is according to research published in the journal Hormone Research in Paediatrics, which gathered data from 22 centers around the world, including the State University of Campinas (Unicamp), in the interior of São Paulo.

The work followed 1,719 children and adolescents for four weeks and identified skin problems in 52% of insulin pump users and in 30% of patients using glucose sensors. Skin inflammation, called eczema, appeared in 9% of participants, both at the pump and sensor sites.

Around 95% of the individuals evaluated had type 1 diabetes, the most common form of the disease in childhood and adolescence. In these cases, the body stops producing insulin, an essential hormone for controlling blood glucose, requiring constant monitoring and continuous treatment with daily insulin applications. Although cases of type 2 diabetes are increasing among children due to obesity and a sedentary lifestyle, type 1 still predominates in this age group.

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"Technological devices, such as glucose sensors and insulin pumps, are mainly indicated for patients with type 1 diabetes, because they allow more precise glycemic control, reduction of hypoglycemia and improved quality of life. International guidelines already consider these technologies as the gold standard of care", says pediatric endocrinologist Mariana Zorron, from Hospital de Clínicas da Unicamp and one of the authors of the article. "But the indication must always be individualized, considering age, clinical profile, access to technology and family support."

These methods allow us to achieve more controlled glycated hemoglobin, which reduces the risk of complications from the disease. "They greatly improve patients' quality of life, facilitate control of the disease, avoid countless bites a day and greatly increase adherence to treatment", says pediatric endocrinologist Lindiane Gomes Crisostomo, from Einstein Hospital Israelita.

The work also draws attention to inequalities in access in Brazil, as these technologies are not fully covered by the Unified Health System (SUS). Glucose sensors have begun to be incorporated into some specialized public services, but insulin pumps still depend, in most cases, on judicialization or specific programs.

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Skin complications
Although technology helps control the disease, the possible appearance of lesions is a reality. In the study, patients using insulin pumps showed more scars, wounds and lipodystrophies, which are changes in the fatty tissue beneath the skin. Furthermore, children with xerosis cutis (excessively dry skin) and keratosis pilaris (a condition that makes the skin drier) had a two to five times higher risk of developing dermatological complications.

"We have to remember that insulin is a medicine that is being injected into that location, with a different pH than the skin, and this can cause inflammation. Furthermore, drier skin, with keratosis pilaris, is more prone to injuries", observes Crisostomo. "So, it's not exactly the technology that causes the problem, but the adhesive, the repeated insertion and the presence of a foreign body in more fragile skin."

Although most injuries are reversible and do not lead to more serious complications, the problem should not be trivialized, as it can hinder treatment. "Skin lesions can compromise the adherence of the device and impair both insulin administration and glucose readings, which may not be adequate," explains Zorron. Infections are rarer, but can also happen.

In general, injuries do not lead to interruption of the use of the devices, but some patients need to temporarily change the application site until the skin recovers.

"Normally, we use strategies such as intense hydration, rotating locations and protective barriers", reports the Einstein doctor. Warning signs are persistent redness, intense itching, sores, discharge and hardening of the skin. The recommendation is to always keep the area clean and well hydrated before applying the devices, and seek medical assistance if there are injuries.

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Source: CNN