Children diagnosed with type 1 diabetes (t1d) depend on insulin, which can be delivered by continuous subcutaneous insulin infusion (csii) attached to the body in combination with or without continuous glucose monitoring (cgm).The previous studies have shown that 43% to 90% of the participating children experienced dermatological complications and that these types of complications tend to present in younger children.Various dermatological complications have been observed including scars, nodules, and eczema (erythema, scaling, papules, and sometimes blisters) due to irritative or allergic contact dermatitis under the adhesives of sensors and pump sets and lipohypertrophy/-atrophy due to insulin infusion.This was a cross-sectional study following up on an initial study.For both studies, informed consent was obtained from participants¿ parents and from adolescents aged 15 years or older.A follow-up questionnaire was sent to all patients four months after the initial study.Both of the questionnaires were sent to either patients or their parents with an online link and were completed at home.Patients answered the questionnaires approximately five months after the initial study.The questionnaire concerning dermatological complications due to csii and/or cgm was the same as that used in the initial study.New questions were included regarding differences in treatment since patients had answered the first questionnaire, why changes were made and whether the patients¿ dermatological complications had changed.Different dermatological complications were separated into groups for further analyses.The following classification was based on the initial study and what the patients were given as options for dermatological complications in the questionnaire.The main groups were itching, specific current dermatological complications (eczema, wounds, and scars), and all currently visible dermatological complications including lipoatrophy, lipohypertrophy, changes in pigmentation, red/blue dot (small hematomas), and other types.In total, 136 patients were currently using csii and 93 patients were using cgm (two patients used cgm only).For five months since the initial trial, itching was the most frequent complication and was reported by 78.7% of csii users and 60.2% of cgm users.Other frequent complaints during this period were dry wounds (csii: 37.5% and cgm: 26.9%) and eczema (csii: 30.9% and cgm: 40.9%).In the follow-up questionnaires, patients also rated their discomfort caused by any current dermatological complications.The patients rated their discomfort to dermatological complications related to cgm as being between a ¿big problem¿ to ¿very big problem¿ (mean: 3.26), whereas csii complications were rated as a ¿moderate problem¿ to ¿big problem¿ (mean: 2.63).Between the initial and follow-up periods, 17 patients (12%) had been using a type of barrier cream and 79% of these patients still had dermatological complications five months later.In total, 17 patients (10 for csii and 15 for cgm) were using patches (an extra adhesive under the cgm or csii to avoid dermatological reactions to the device) and an association between having all current skin problems during the initial study and developing eczema five months later was found (odds ratio [or]: 5.6).When analyzing cgm types, patients were either using enlite, , or . was excluded from the analysis due to the lack of power with only six patients using .Among 94 patients who were currently using cgm, 75% of the patients using enlite were experiencing itching in response to cgm treatment vs 41% of the patients on .In total, 58% of the patients on enlite had the current dermatological complications against 21% using .In conclusion, researchers found no improvement in dermatological complications to csii and cgm over a five-month period.This suggests that better preventive care and new treatment modalities are needed since greater levels of discomfort are associated with lower quality of life and an increased disease burden.
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