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ULTRASOUND MEASURED VASCULARIZATION AND ECHOGENICITY IN THE SUBCUTIS – A PROSPECTIVE STUDY SHOWING SKIN REACTIONS TO DIABETES DEVICES IN PEDIATRIC PATIENTS WITH TYPE 1 DIABETES
Abstract
Background and Aims
Many pediatric Type 1 diabetic patients using continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) have skin issues (1). The aim was therefore to investigate subcutis (Sc) as a measure of underlying skin.
Methods
Ultrasound during first year after initiation of a new CSII or CGM showed echogenicity and pathologic vascularization of the Sc at CSII and CGM sites. Binomial Generalized Linear Mixed Models was applied to detect significant changes in vascularization and echogenicity over time.
Results
These preliminary data consist of 124 CGM-participants and 66 CSII-participants with respectively 43 and 15 who completed last visit. The figure shows the proportion of vascularization, hyper- and hypoechogenicity of the Sc. The frequency of hyperechogenicity was more than 50% at all visits. The frequency of vascularization of the Sc at the pump sites was 3% at baseline and 13 % after 12 months but without significant change (p=0.131). Sc changes were rare at CGM-sites. At the 12th month, mean HbA1c was 60.38 mmol/L and 48.4 mmol/L respectively for patients with and without hyperechogenicity at the pump site (p < 0.001).
Conclusions
The frequency of hyperechogenic CSII sites were quite high at all visits and were significantly associated with high HbA1c after 12 months. Vascularization were seen in more than 10 % of the CSII patients after 12 months. These findings suggest that hyperechogenicity primary occurs at pump and not sensor sites and that it might help blood sugar control if a method to reduce hyperechogenicity was found.