Dermatological complications of insulin therapy in children with type 1 diabetes

Dermatological complications at insulin administration sites, like lipohypertrophy, lipoatrophy and erythema, are common in children with type 1 diabetes. These complications can be painful, disfiguring and may influence glycaemic control. Studies on epidemiology and etiology are needed before prevention or treatment is possible.

The aim of this study is to determine the prevalence of common dermatological complications in children with type 1 diabetes and to assess associations between dermatological complications and possible risk factors.

In this cross-sectional study 231 children with type 1 diabetes were included. Dermatological complications were assessed and a questionnaire with possible risk factors was completed. Data were evaluated using χ² tests.

The results showed that lipohypertrophy was present in 34.8% of the children, lipoatrophy in 8.1% and erythema in 24.6%. Lipohypertrophy was associated with multiple daily injection therapy (p=0.03) and insufficiency of alternating administration sites (p<0.001). Lipoatrophy was not influenced by type of insulin therapy (p=0.44) but was found to be associated with less frequent injection site alternation in patients using multiple daily injections (p=0.01). Also, HbA1c level was positively associated with lipoatrophy (p=0.01). Erythema of the skin was more frequently diagnosed in children with continuous subcutaneous insulin pump therapy (p<0.001). A history of cutaneous infections and dry skin on exam day were independently associated with erythema at insulin administration sites (p<0.001 and 0.04, respectively).

Dermatological complications are a common problem in children with type 1 diabetes making frequent examination of the skin in these children an important aspect of their medical care.