Diabetes devices--insulin infusion sets, patch pumps, flash and continuous glucose sensors--all involve adhesive patches adhered to the user’s skin. Wear is often for an extended amount of time (3-14 days), and requires continued, repeated exposure to chemical and mechanical agents. As a result, exposure to adhesives lead to acute and chronic skin problems that may impede comfortable use of diabetes devices. The aim of this presentation is to delineate types of skin complications associated with diabetes devices, and discuss strategies to optimize skin protection, adhesion, removal, and healing.
Review of current literature was undertaken to determine types of common skin reactions to diabetes devices, and recommendations for treatment and sustained device use
Skin complications from device use can be delineated into two primary categories: Contact irritation and contact allergy. Contact irritation causes direct damage to skin via chemical or mechanical agents, and results in a non-immune inflammatory response. Contact allergy is a hypersensitization of the immune response to a chemical agent in the adhesive. It can be immediate (Type 1 hypersensitivity, IgE mediated) or delayed (Type 4 sensitivity T-cell mediated). Contact allergy has been documented in response to isobornyl acrylate, colophonium, ethyl cyanoacrylate and N,N-dimethylacrylamide. Different devices contain different agents in their adhesives.
To minimize complications from contact dermatitis, clinicians should discuss prophylactic strategies with users, including skin preparation and chemical/physical barriers. Adhesive problems can be addressed with overpatches and tackifiers. Sensor removal agents and techniques are important for healing. For contact allergy, it may be possible to use a skin protecting layer between the native adhesive ad skin, however complete avoidance of the offending agent is often indicated. Overall, device manufacturers should increase transparency about chemical agents found in device adhesives, and careful skin care may reduce incidence of complications.