A Skin Care Program to Prevent Skin Problems due to Diabetes Devices in Children and Adolescents: A Cluster-Controlled Intervention Study

Objective: Diabetes devices that deliver insulin and measure blood glucose are cornerstones in modern treatment of type 1 diabetes. However, their use is frequently associated with the development of skin problems, particularly eczema and wounds. Proper skin care may prevent skin problems, yet evidence-based information from interventional studies is missing, which therefore is the aim of this study.

Research Design and Methods: This first cluster-controlled intervention study tested the efficacy of a basic skin care program (including use of lipid cream, removal, and avoidance of disinfection). A total of 170 children and adolescents with type 1 diabetes were included and assigned either to the intervention group (n=112) or the control group (n=58). Participants were seen quarterly the first year after device initiation with clinical assessment and interview in an unblinded setting. 

Results: Eczema or wounds were observed in 33.6% of the intervention group compared to 46.6% of control participants with absolute difference of 12.9% [95% CI: -28.7%;2.9%], p = 0.10. The adjusted odds of wounds were decreased by 71% in the intervention compared to control group – odds ratio for wounds of 0.29 [95% CI: 0.12;0.68], p = 0.005. In total, only eight infections were seen without a higher frequency in the intervention group despite advice of omitting disinfection. 

Conclusions: These data indicate our basic skin care program partially prevented diabetes device-induced skin reactions. However, further preventive strategies with other adhesives, patches and/or types of lotions are still needed for optimized prevention.