Background and Aims

There are no studies evaluating the human skin changes related to continuous subcutaneous insulin infusion (CSII). The aim of this study is to characterize changes at CSII sites in patients with T1D using traditional histopathology and novel non-invasive skin imaging (optical coherence tomography; OCT).

Methods

31 patients with T1D were enrolled. Demographics, diabetes data and blood samples were obtained. OCT assessments and punch biopsies were collected at: 1) current and 2) prior CSII sites and 3) control (never-used) site. Histologic changes were visually scored.

Results

Table 1 shows population characteristics. CSII sites showed a significant increase in epidermal thickness, inflammation, fibrin, fat necrosis and vascularity compared to control sites. OCT demonstrated a significant difference in vascular density (VD) and optical attenuation coefficient (OAC) between CSII and control sites (Table 2). No significant differences were observed between prior and current CSII sites.

Table 1

Table 2

*p-value (Kruskal-Wallis rank sum test) <0.001

Conclusions

Significant changes in the skin were observed by both histology and OCT at CSII sites. The impact of these changes on CSII function warrants further study.