Ultrasound Detected Subcutaneous Changes in a Pediatric Cohort after Initiation of a New Insulin Pump or Glucose Sensor
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Ultrasound Detected Subcutaneous Changes in a Pediatric Cohort after Initiation of a New Insulin Pump or Glucose Sensor. / Sørensen, Fiona M.W.; Svensson, Jannet; Kinnander, Christina; Berg, Anna K.
I: Diabetes Technology and Therapeutics, Bind 25, Nr. 9, 2023, s. 622-630.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Ultrasound Detected Subcutaneous Changes in a Pediatric Cohort after Initiation of a New Insulin Pump or Glucose Sensor
AU - Sørensen, Fiona M.W.
AU - Svensson, Jannet
AU - Kinnander, Christina
AU - Berg, Anna K.
N1 - Publisher Copyright: Copyright © 2023, Mary Ann Liebert, Inc., publishers 2023.
PY - 2023
Y1 - 2023
N2 - Objective: This study examined subcutaneous tissue changes at sites used by continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM), and tested whether these changes, if any, were associated with glycated hemoglobin (HbA1c). Research Design and Methods: This prospective study investigated recently used CSII or CGM sites in 161 children and adolescents during the first year after initiation of a new diabetes device. Subcutaneous changes such as echogenicity, vascularization, and the distance from the skin surface to the muscle at CSII and CGM sites were assessed by ultrasound. Results: The distance from skin surface to muscle fascia at both the upper arm and abdomen was influenced by age, body mass index z-score, and sex. Especially in boys and the youngest, the depth of many devices outreached the mean distance. The mean distance for boys at the abdomen and upper arm ranged from 4.5-6.5 mm and 5-6.9 mm for all ages, respectively. Hyperechogenicity at CGM sites was 4.3% after 12 months. The frequency of subcutaneous hyperechogenicity and vascularization at CSII sites increased significantly over time (41.2% to 69.3% and 2% to 16% respectively, P < 0.001 and P = 0.009). Hyperechogenicity in the subcutis was not a predictor of elevated HbA1c (P = 0.11). Conclusion: There is large variation in the distance from the skin surface to the muscle fascia and many diabetes devices reach even deeper. Hyperechogenicity and vascularization increased significantly over time at CSII sites, but not CGM sites. The importance of hyperechogenicity for insulin absorption is unclear and further investigations are needed. Clinical Trial Registration number: NCT04258904.
AB - Objective: This study examined subcutaneous tissue changes at sites used by continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM), and tested whether these changes, if any, were associated with glycated hemoglobin (HbA1c). Research Design and Methods: This prospective study investigated recently used CSII or CGM sites in 161 children and adolescents during the first year after initiation of a new diabetes device. Subcutaneous changes such as echogenicity, vascularization, and the distance from the skin surface to the muscle at CSII and CGM sites were assessed by ultrasound. Results: The distance from skin surface to muscle fascia at both the upper arm and abdomen was influenced by age, body mass index z-score, and sex. Especially in boys and the youngest, the depth of many devices outreached the mean distance. The mean distance for boys at the abdomen and upper arm ranged from 4.5-6.5 mm and 5-6.9 mm for all ages, respectively. Hyperechogenicity at CGM sites was 4.3% after 12 months. The frequency of subcutaneous hyperechogenicity and vascularization at CSII sites increased significantly over time (41.2% to 69.3% and 2% to 16% respectively, P < 0.001 and P = 0.009). Hyperechogenicity in the subcutis was not a predictor of elevated HbA1c (P = 0.11). Conclusion: There is large variation in the distance from the skin surface to the muscle fascia and many diabetes devices reach even deeper. Hyperechogenicity and vascularization increased significantly over time at CSII sites, but not CGM sites. The importance of hyperechogenicity for insulin absorption is unclear and further investigations are needed. Clinical Trial Registration number: NCT04258904.
KW - Continuous glucose monitoring
KW - Continuous subcutaneous insulin infusion
KW - Pediatric
KW - Subcutis
KW - Type 1 diabetes
KW - Ultrasound
U2 - 10.1089/dia.2023.0137
DO - 10.1089/dia.2023.0137
M3 - Journal article
C2 - 37279034
AN - SCOPUS:85169847738
VL - 25
SP - 622
EP - 630
JO - Diabetes Technology & Therapeutics
JF - Diabetes Technology & Therapeutics
SN - 1520-9156
IS - 9
ER -
ID: 370473499