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Clinical review: insulin pump-associated adverse events in adults and children

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Abstract

Aims

Insulin pumps are a vital and rapidly developing tool in the treatment of type 1 diabetes mellitus in both adults and children. Many studies have highlighted outcomes and assessed their potential advantages, but much of the data on adverse outcomes are limited and often based on outdated technology. We aimed to review and summarize the available literature on insulin pump-associated adverse events in adults and children.

Methods

A literature search was undertaken using PubMed, EMBASE, and the Cochrane library. Articles were then screened by title, followed by abstract, and full text as needed. A by-hand search of reference lists in identified papers was also utilised. All searches were limited to English language material, but no time limits were used.

Results

Current and past literature regarding insulin pump-associated adverse events is discussed, including potential metabolic and non-metabolic adverse events, in particular: pump malfunction; infusion set/site issues; and cutaneous problems. We show that even with modern technology, adverse events are common, occurring in over 40 % of users per year, with a minority, particularly in children, requiring hospital management. Hyperglycaemia and ketosis are now the most common consequences of adverse events and are usually associated with infusion set failure. This differs from older technology where infected infusion sites predominated.

Conclusions

This timely review covers all potential insulin pump-associated adverse events, including their incidence, features, impacts, and contributory factors such as the pump user. The importance of ongoing anticipatory education and support for patients and families using this intensive insulin technology is highlighted, which if done well should improve the overall experience of pump therapy for users, and hopefully reduce the incidence and impact of severe adverse events.

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References

  1. The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986

    Article  Google Scholar 

  2. Nathan DM, Cleary PA, Backlund JY et al (2005) Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 353:2643–2653

    Article  PubMed  Google Scholar 

  3. Pickup JC, Yemane N, Brackenridge A, Pender S (2014) Nonmetabolic complications of continuous subcutaneous insulin infusion: a patient survey. Diab Technol Ther 16:145–149

    Article  CAS  Google Scholar 

  4. Guilhem I, Balkau B, Lecordier F et al (2009) Insulin pump failures are still frequent: a prospective study over 6 years from 2001 to 2007. Diabetologia 52:2662–2664

    Article  CAS  PubMed  Google Scholar 

  5. Wheeler BJ, Donaghue KC, Heels K, Ambler GR (2014) Family perceptions of insulin pump adverse events in children and adolescents. Diab Technol Ther 16:204–207

    Article  CAS  Google Scholar 

  6. Wheeler BJ, Heels K, Donaghue KC, Reith DM, Ambler GR (2014) Insulin pump-associated adverse events in children and adolescents—a prospective study. Diab Technol Ther 16:558–562

    Article  CAS  Google Scholar 

  7. Cope JU, Samuels-Reid JH, Morrison AE (2012) Pediatric use of insulin pump technology: a retrospective study of adverse events in children ages 1–12 years. J Diab Sci Technol 6:1053–1059

    Article  Google Scholar 

  8. Mecklenburg RS, Benson EA, Benson JW Jr et al (1984) Acute complications associated with insulin infusion pump therapy. Report of experience with 161 patients. JAMA 252:3265–3269

    Article  CAS  PubMed  Google Scholar 

  9. Knight G, Jennings AM, Boulton AJ, Tomlinson S, Ward JD (1985) Severe hyperkalaemia and ketoacidosis during routine treatment with an insulin pump. Br Med J 291:371–372

    Article  CAS  Google Scholar 

  10. Cope JU, Morrison AE, Samuels-Reid J (2008) Adolescent use of insulin and patient-controlled analgesia pump technology: a 10-year Food and Drug Administration retrospective study of adverse events. Pediatrics 121:e1133–e1138

    Article  PubMed  Google Scholar 

  11. Guilhem I, Leguerrier AM, Lecordier F, Poirier JY, Maugendre D (2006) Technical risks with subcutaneous insulin infusion. Diab Metab 32:279–284

    Article  CAS  Google Scholar 

  12. Scaramuzza AE, Dell’Acqua M, Macedoni M, Zuccotti GV (2013) Insulin pump therapy in children with type 1 diabetes: the dark side of the moon. J Diab Sci Technol 7:1095–1097

    Google Scholar 

  13. Schmid V, Hohberg C, Borchert M, Forst T, Pfutzner A (2010) Pilot study for assessment of optimal frequency for changing catheters in insulin pump therapy-trouble starts on day 3. J Diab Sci Technol 4:976–982

    Article  Google Scholar 

  14. Hoogma RP, Hammond PJ, Gomis R et al (2006) Comparison of the effects of continuous subcutaneous insulin infusion (CSII) and NPH-based multiple daily insulin injections (MDI) on glycaemic control and quality of life: results of the 5-Nations trial. Diab Med 23:141–147

    Article  CAS  Google Scholar 

  15. Hirsch IB, Farkas-Hirsch R, McGill JB (1992) Catheter obstruction with continuous subcutaneous insulin infusion Effect of insulin concentration. Diab Care 15:593–594

    Article  CAS  Google Scholar 

  16. Walter HM, Timmler R, Mehnert H (1990) Stabilized human insulin prevents catheter occlusion during continuous subcutaneous insulin infusion. Diab Res 13:75–77

    CAS  Google Scholar 

  17. Johansson UB, Adamson U, Lins PE, Wredling R (2005) Patient management of long-term continuous subcutaneous insulin infusion. J Adv Nurs 51:112–118

    Article  PubMed  Google Scholar 

  18. Hojbjerre L, Skov-Jensen C, Kaastrup P, Pedersen PE, Stallknecht B (2009) Effect of steel and teflon infusion catheters on subcutaneous adipose tissue blood flow and infusion counter pressure in humans. Diab Technol Ther 11:301–306

    Article  Google Scholar 

  19. Patel PJ, Benasi K, Ferrari G et al (2014) Randomized trial of infusion set function: steel versus teflon. Diab Technol Ther 16:15–19

    Article  CAS  Google Scholar 

  20. Renard E, Guerci B, Leguerrier AM, Boizel R (2010) Accu-Chek FlexLink Study G. Lower rate of initial failures and reduced occurrence of adverse events with a new catheter model for continuous subcutaneous insulin infusion: prospective, two-period, observational, multicenter study. Diab Technol Ther 12:769–773

    Article  Google Scholar 

  21. Kerr D, Wizemann E, Senstius J, Zacho M, Ampudia-Blasco FJ (2013) Stability and performance of rapid-acting insulin analogs used for continuous subcutaneous insulin infusion: a systematic review. J Diab Sci Technol 7:1595–1606

    Google Scholar 

  22. Mecklenburg RS, Guinn TS, Sannar CA, Blumenstein BA (1986) Malfunction of continuous subcutaneous insulin infusion systems: a one-year prospective study of 127 patients. Diab Care 9:351

    Article  CAS  Google Scholar 

  23. van Bon AC, Bode BW, Sert-Langeron C, DeVries JH, Charpentier G (2011) Insulin glulisine compared to insulin aspart and to insulin lispro administered by continuous subcutaneous insulin infusion in patients with type 1 diabetes: a randomized controlled trial. Diab Technol Ther 13:607–614

    Article  Google Scholar 

  24. Bode BW (2011) Comparison of pharmacokinetic properties, physicochemical stability, and pump compatibility of 3 rapid-acting insulin analogues-aspart, lispro, and glulisine. Endocr Pract 17:271–280

    Article  PubMed  Google Scholar 

  25. Kerr D, Morton J, Whately-Smith C, Everett J, Begley JP (2008) Laboratory-based non-clinical comparison of occlusion rates using three rapid-acting insulin analogs in continuous subcutaneous insulin infusion catheters using low flow rates. J Diab Sci Technol 2:450–455

    Article  Google Scholar 

  26. Lopez PE, King BR, Goss PW, Chockalingam G (2014) Bubble formation occurs in insulin pumps in response to changes in ambient temperature and atmospheric pressure but not as a result of vibration. BMJ Open Diab Res Care 2:e000036

    Article  PubMed Central  PubMed  Google Scholar 

  27. King BR, Goss PW, Paterson MA, Crock PA, Anderson DG (2011) Changes in altitude cause unintended insulin delivery from insulin pumps: mechanisms and implications. Diab Care 34:1932–1933

    Article  Google Scholar 

  28. Conwell LS, Pope E, Artiles AM, Mohanta A, Daneman A, Daneman D (2008) Dermatological complications of continuous subcutaneous insulin infusion in children and adolescents. J Pediatr 152:622–628

    Article  CAS  PubMed  Google Scholar 

  29. Radermecker RP, Pierard GE, Scheen AJ (2007) Lipodystrophy reactions to insulin: effects of continuous insulin infusion and new insulin analogs. Am J Clin Dermatol 8:21–28

    Article  PubMed  Google Scholar 

  30. Saccabusi S, Boatto G, Asproni B, Pau A (2001) Sensitization to methyl methacrylate in the plastic catheter of an insulin pump infusion set. Contact Dermat 45:47–48

    Article  CAS  Google Scholar 

  31. Schober E, Rami B (2009) Dermatological side effects and complications of continuous subcutaneous insulin infusion in preschool-age and school-age children. Pediatr Diab 10:198–201

    Article  Google Scholar 

  32. Heinemann L, Krinelke L (2012) Insulin infusion set: the Achilles heel of continuous subcutaneous insulin infusion. J Diab Sci Technol 6:954–964

    Article  Google Scholar 

  33. Rosenbloom AL (2014) Insulin injection lipoatrophy recidivus. Pediatr Diab 15:73–74

    Article  Google Scholar 

  34. Hanas R, Lindgren F, Lindblad B (2009) A 2-yr national population study of pediatric ketoacidosis in Sweden: predisposing conditions and insulin pump use. Pediatr Diab 10:33–37

    Article  Google Scholar 

  35. Shalitin S, Phillip M (2008) The use of insulin pump therapy in the pediatric age group. Horm Res 70:14–21

    Article  CAS  PubMed  Google Scholar 

  36. Scheen A, Castillo M, Jandrain B et al (1984) Metabolic alterations after a two-hour nocturnal interruption of a continuous subcutaneous insulin infusion. Diab Care 7:338–342

    Article  CAS  Google Scholar 

  37. Guerci B, Meyer L, Salle A et al (1999) Comparison of metabolic deterioration between insulin analog and regular insulin after a 5-hour interruption of a continuous subcutaneous insulin infusion in type 1 diabetic patients. J Clin Endocrinol Metab 84:2673–2678

    CAS  PubMed  Google Scholar 

  38. Radermecker RP, Scheen AJ (2004) Continuous subcutaneous insulin infusion with short-acting insulin analogues or human regular insulin: efficacy, safety, quality of life, and cost-effectiveness. Diab Metab Res Rev 20:178–188

    Article  CAS  Google Scholar 

  39. Realsen J, Goettle H, Chase HP (2012) Morbidity and mortality of diabetic ketoacidosis with and without insulin pump care. Diab Technol Ther 14:1149–1154

    Article  Google Scholar 

  40. Johnson SR, Cooper MN, Jones TW, Davis EA (2013) Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case–control study. Diabetologia 56:2392–2400

    Article  CAS  PubMed  Google Scholar 

  41. Yeh HC, Brown TT, Maruthur N et al (2012) Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med 157:336–347

    Article  PubMed  Google Scholar 

  42. Misso Marie L, Egberts Kristine J, Page M, O’Connor D, Shaw J (2010) Continuous subcutaneous insulin infusion (CSII) versus multiple insulin injections for type 1 diabetes mellitus. Cochrane Datab Syst Rev 20(1):CD005103. doi:10.1002/14651858.CD005103.pub2

  43. Cooper MN, O’Connell SM, Davis EA, Jones TW (2013) A population-based study of risk factors for severe hypoglycaemia in a contemporary cohort of childhood-onset type 1 diabetes. Diabetologia 56:2164–2170

    Article  PubMed  Google Scholar 

  44. Bode BWTW, Davidson PC (2002) Insulin pump therapy in the 21st century: strategies for successful use in adults, adolescents, and children with diabetes. Postgrad Med 111:69

    Article  PubMed  Google Scholar 

  45. Pickup JC, Sutton AJ (2008) Severe hypoglycaemia and glycaemic control in type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diab Med 25:765–774

    Article  CAS  Google Scholar 

  46. Cryer PE, Davis SN, Shamoon H (2003) Hypoglycemia in diabetes. Diab Care 26:1902–1912

    Article  CAS  Google Scholar 

  47. Wredling R, Lin PE, Adamson U (1989) Pump, “run-away” causing severe hypoglycaemia. Lancet 2:273

    Article  CAS  PubMed  Google Scholar 

  48. Heinemann L, Fleming GA, Petrie JR, Holl RW, Bergenstal RM, Peters AL (2015) Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting, and research needs: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diab Care 38:716–722

    Article  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This article does not contain any studies with human participants performed by any of the authors.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Women’s and Children’s Health, University of Otago, PO Box 913, Dunedin, 9054, New Zealand

    P. L. Ross, D. M. Reith & B. J. Wheeler

  2. Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand

    J. Milburn & B. J. Wheeler

  3. Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand

    E. Wiltshire

  4. Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand

    B. J. Wheeler

Authors
  1. P. L. Ross
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  2. J. Milburn
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  3. D. M. Reith
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  4. E. Wiltshire
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  5. B. J. Wheeler
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Correspondence to B. J. Wheeler.

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Ross, P.L., Milburn, J., Reith, D.M. et al. Clinical review: insulin pump-associated adverse events in adults and children. Acta Diabetol 52, 1017–1024 (2015). https://doi.org/10.1007/s00592-015-0784-2

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  • DOI: https://doi.org/10.1007/s00592-015-0784-2

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