Insulin pump failure in children with type 1 diabetes

This study investigated failure of insulin pumps in children and adolescents with type 1 diabetes (T1D). It was determined that insulin pumps failed at a rate of 4.5% per year in these patients.

A traditional insulin pump is a small device that continuously delivers insulin, without the need for multiple daily injections. An additional bolus injection can be given before meals. Some insulin pumps also measure glucose levels throughout the day by placing a sensor in the fat just under the skin.

An insulin pump may fail to deliver insulin correctly, resulting in prolonged hyperglycemia (high blood glucose levels) or diabetic ketoacidosis (life-threatening emergency). Insulin pumps may fail when the tube that delivers insulin (cannula) is blocked, kinked, or falls out of the space under the skin. Few studies have investigated insulin pump failures in children.

1046 children and adolescents with T1D participated in this study. They were all receiving treatment with an insulin pump. They were monitored for failure of the insulin pump for 1 year.

Insulin pumps failed in 4.5% of participants per year. The most common failures were hyperglycemia and air bubbles forming in the pump’s tubes. Hyperglycemia and bubbles were more common in younger children, in those who used insulin lispro than who used insulin aspart, and in those who changed the cannula more often. Younger children were also more likely to have infections, increased fat under the skin (lipohypertrophy), and bleeding, but were less likely to have a blocked pump, or leaking of insulin from the pump (tunneling).

Using insulin aspart was associated with a lower risk of kinking of the cannula, but a higher risk of bleeding. Using insulin glulisine instead of insulin lispro, was associated with a higher risk of pump blockage, lipohypertrophy, and bleeding, and a lower risk of tunneling.

Changing the cannula more often was also associated with a higher risk of kinking, lipohypertrophy, and bleeding. Inserting the cannula at an angle, rather than straight through the skin, decreased the risk of hyperglycemia, dislodgement of the pump, and bleeding, but increased the risk of infection.

Using insulin pumps longer was associated with a higher risk of lipohypertrophy. Infection was the least common failure, and was more likely in younger children.

The participants who had lipohypertrophy were more likely to have higher HbA1c levels (measures average blood glucose over the last 3 months). No incidents of diabetic ketoacidosis or severe hypoglycemia occurred due to failure of an insulin pump.

The study concluded that the rate of insulin pump failures was 4.5% per year in children and adolescents with T1D. Hyperglycemia and bubbles were the most common failures, and infection was the least common. It was also determined that lipohypertrophy was associated with higher HbA1c levels.

Novo Nordisk, who manufacture medications to treat T1D, funded this study. All of the participants in this study were Italian, so the results may not apply equally to all children and adolescents with T1D.

Discuss the benefits and risks of insulin pumps with your physician.