Frequency of dermatological side effects of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes.

BACKGROUND: The incidence of type 1 diabetes is rising, particularly in young infants. The treatment with continuous subcutaneous insulin infusion (CSII) offers certain benefits and has gained popularity. Insulin-pump therapy could be associated with cutaneous-adverse effects. The purpose of our study was to investigate the frequency and characterization of skin-related complications in patients with CSII. METHODS: In a single center setting, 54 patients (28 male, 26 female) on CSII therapy aged between 3 and 20 years participated in our study. Data including duration of diabetes, duration of CSII, pump model, catheter material, frequency of catheter switch and hygiene procedures at time of puncture were collected through a standardized questionnaire and photographs of affected areas of the skin were made. Statistical analysis was done to verify an association with gender, patients' age, HbA1c values, and body mass index. RESULTS: Our observation revealed skin complications at the site of catheter insertion in 43% (8 f, 15 m) of our patients. A frequent occurrence of scars (24%, 6 f, 7 m), lipohypertrophic areas (20%, 4 f, 7 m) and eczema (11%, 1 f, 5 m) was observed. Furthermore, 6% (1 f, 2 m) showed changes in pigmentation and 6% (1 f, 2 m) lipoatrophy. The catheter localization had to be switched due to skin-complications in 24% (6 f, 7 m) whereas none of our patients discontinued insulin-pump therapy. CONCLUSION: Skin-related complications during CSII are frequent and regular examination of the insertion sites is crucial. To verify the occurrence of lipoatrophy associated with insulin pump therapy - an otherwise rare complication - larger studies would be needed.

Insulin pump treatment in children and adolescents with type 1 diabetes.

Within children and adolescents with type 1 diabetes insulin pump treatment is of increasing interest. Frequency of insulin pump therapy shows a rapid and steep increase in toddlers and young children. Insulin pumps allow a close to physiologic insulin delivery due to basal rates programmed over 24 hours with circadian rhythms taken into account. Furthermore, another advantage of technical devices as insulin pumps is the application of extremely small amounts of insulin, as needed in very young children, with the possibility of titration of infusion rates down to 0.01E/h. Dawn Phenomenon and hypoglycemic events are main indications for insulin pump treatment in children and adolescents. A significant reduction of severe hypoglycemia, especially nocturnal hypoglycemia was shown, whereas a reduction of HbA1c and an improvement of metabolic control has been reported in short term and in some but not all long term studies. Ketoacidosis rate did not increase in insulin pump therapy. Complications due to continuous subcutaneous insulin infusion, like local infections and dermatological changes are frequent but were not associated with glycemic control and did not lead to discontinuation of insulin pump treatment. Pump discontinuation rate in general is low, varying from 1% in very young children up to 6% in pubertal adolescent girls. Insulin pump treatment was shown to be safe and efficient and the simplicity of handling the devices as well as an improvement of quality of life may explain the rapid increase of pump treatment in young children and adolescents with type 1 diabetes.

Living at high altitude and risk of hospitalisation for atopic asthma in children: results from a large prospective birth-cohort study.

BACKGROUND: Asthma is among the most common chronic diseases in childhood and is steadily increasing in prevalence. Better characterisation of factors that determine the risk of hospitalisation for atopic asthma in childhood may help design prevention programmes and improve our understanding of disease pathobiology. This study will focus on the altitude of residence. METHODS: This is an ongoing prospective birth-cohort study that enrolled all live-born infants in the Tyrol. Between 1994 and 1999, baseline data were collected for 33 808 infants. From 2000 to 2005, all children hospitalised for atopic asthma at the age of > or =6 years (n = 305) were identified by a careful search of hospital databases. Disease status was ascertained from the typical medical history, a thorough examination and proof of atopy. RESULTS: Living at higher altitude was associated with an enhanced risk of hospitalisation for atopic asthma (multivariate RRs (95% confidence interval 2.08 (1.45 to 2.98) and 1.49 (1.05 to 2.11) for a comparison between altitude categories > or =1200 m and 900-1199 m versus <900 m; p<0.001). This finding applied equally to hospital admissions in spring, summer, autumn and winter. When altitude of residence was analysed as a continuous variable, the risk for asthma hospitalisation increased by 7% for each 100-m increase in altitude (p = 0.013). CONCLUSIONS: This large prospective study shows a significant association between the risk of hospitalisation for atopic asthma and altitude of residence between 450 and 1800 m. The underlying mechanisms remain to be elucidated, but it is tempting to speculate about a role for altitude characteristics such as the decline in outdoor temperature and air humidity and increase in ozone levels, which may trigger airway hyper-responsiveness and attenuate lung function.