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Panel offers recommendations on IIS-related insulin pump treatment issues
In patients with diabetes, the experience of insulin pump treatment appears to be strongly affected by factors related to the insulin infusion set, including infusion set dislodgement, complete or partial blockage of the cannula, skin reactions, challenges involving site rotation and set changes, and unanticipated variations in insulin absorption, according to findings from a panel of diabetologists and certified diabetes educators
The expert panel convened in New Orleans in 2015 with the objective of revisiting insulin infusion set (IIS)-related complications of pump therapy and identifying updated priorities for maximizing the use of current technologies. The panel formulated actionable guidelines that built upon recommendations established in a 2011 white paper published by the American College of Diabetes Educators.
The panel addressed IIS selection, which should be based on patient age, diabetes duration, dexterity issues, dermatologic conditions, physical activity, and the preference of patient and caregiver. For each of the most common IIS malfunctions, the panel offered patient considerations, clinician/educator considerations and a recommended course of action.
In terms of site selection, the panel noted that new pump therapy patients often prefer easily accessible and visible sites, such as the abdomen or thigh. The following were also listed as common sites: the upper buttocks, the back of the arm, the lower back and, in pregnant women, just below the waistline on the side of the body.
The panel advised early, regular patient education regarding the importance of site rotation to decrease risk for lipohypertrophy and other skin pathologies. The experts proposed a waiting room patient handout, which would include a questionnaire to gather information and provide troubleshooting strategies regarding duration of diabetes, length of time on the pump, glucose measurements, frequency of bolusing, total daily insulin dose, and infusion site rotation and maintenance practices.
Recommendations for skin preparations and maintenance were made, including washing skin thoroughly before a site change, wiping skin in an outward spiral vs. back and forth, allowing site to air dry, and considering the use of alcohol-free antibacterial products and anchoring Teflon infusion lines with 1-inch tape. Lastly, the panel advised that ongoing IIS practices and maintenance information should be more prominently displayed in pump manuals and brochures. It called for third-party reimbursement of at least one face-to-face visit soon after original training to adjust equipment, assess IIS placement and technique, and encourage healthy IIS habits.
“Patient and clinician testimony indicates that the experience of pump therapy is strongly influenced by infusion set factors — including dislodgement of the infusion set, partial or complete blockage of the cannula, skin reactions, the demands of site rotation and set changes, and unpredictable variations in insulin absorption,” the researchers wrote. “The goal of this article is to raise awareness of day-to-day practice challenges faced by clinicians and patients, offer achievable solutions, and recommend pathways for action and future research.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.