SKIN-PEDIC: A Worldwide Assessment of Skin Problems in Children and Adolescents Using Diabetes Devices Available to Purchase

Introduction: Children and adolescents with diabetes are increasingly using technological devices to maintain normoglycemia. However, skin problems associated with these devices are becoming a significant issue. This study aimed to investigate prevalence of skin issues in children and adolescents with diabetes globally and identify important factors associated with these skin problems. Methods: This multinational study involved 22 pediatric diabetes centers. Over a 4-week period, pseud anonymized data were collected on children and adolescents using diabetes devices, including demographic factors, visual skin problems, type of devices and products being used. Univariate logistic regression was applied to identify associations with skin problems. Results: A total of 1,719 children and adolescents were included. Skin problems were present in 52% of pump users compared to 30% of sensor users. Eczema was found in 9% of participants at both insulin pump and glucose sensor sites, whereas scars, wounds, and lipodystrophies were significantly more frequent at insulin pump sites than at glucose sensor sites. Both xerosis cutis and keratosis pilaris were strongly associated with almost all types of skin problems, increasing the risk 2 to fivefold. Conclusion: Skin problems are a serious concern that limits the use of diabetes devices in children and adolescents, consequently increasing risk for long-term complications. This study highlights the extent of the problem in a real-world setting of unselected participants despite the use of preventive strategies. Consequently, the development of more skin-friendly devices is needed to ensure that all children and adolescents with diabetes can effectively use these devices in the long term.