Clinical review: insulin pump-associated adverse events in adults and children
- 1.1k Downloads
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and assessed their potential advantages, but much of the data on adverse outcomes are limited and often based on outdated technology.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.
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.
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.
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.
KeywordsType 1 diabetes Insulin pump Continuous subcutaneous insulin infusion Adverse event
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
Human and animal rights
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 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 7:1095–1097Google Scholar
- 16.Walter HM, Timmler R, Mehnert H (1990) Stabilized human insulin prevents catheter occlusion during continuous subcutaneous insulin infusion. Diab Res 13:75–77Google 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 12:769–773CrossRefGoogle 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 7:1595–1606Google 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 13:607–614CrossRefGoogle 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
- 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 38:716–722CrossRefGoogle Scholar