Optimising Skin Health with Wearable Diabetes Technology

The Symptoms and Causes of Skin Reactions

There are Two Common Types—And Some Less Common

Skin reactions from wearable diabetes devices generally fall into two categories. It is essential to identify the type of reaction to tailor appropriate interventions for your patients.

A Type IV hypersensitivity reaction caused by repeated exposure to allergens such as adhesives or plastic components. Symptoms include redness, swelling, intense itching, and sometimes vesicles or blisters. These reactions can escalate with ongoing exposure.

Other, less common reactions include: hematomas from insertion trauma, infections due to skin-barrier breaches, and pigment changes (hypo- or hyperpigmentation).

Risk Factors

Risk factors for skin reactions are both intrinsic and extrinsic:⁷

Intrinsic Factors:

Age extremes (neonates and elderly), existing skin conditions (e.g., atopic dermatitis), and medical conditions such as diabetes and kidney disease increase susceptibility to skin issues.

Extrinsic Factors:

Prolonged exposure to adhesives, improper device placement, dry skin, and environmental factors like humidity and temperature can exacerbate reactions.

Strategies for Prevention and Management

Prevention Tips:

Proactive measures can significantly reduce the risk of skin reactions:⁸ 

Good Skin Hygiene:

Encourage patients to bathe with pH-balanced cleansers and moisturise with creams like CeraVe immediately after bathing. Avoid alcohol-based cleansers, which can dry and irritate the skin.

Barrier Protection:

Recommend barrier sprays or hydrocolloid dressings under devices to minimize direct adhesive contact with the skin.

Device Placement and Rotation:

Educate patients on proper device placement and rotation to prevent prolonged pressure on a single area. Follow the Pod Placement Guide and utilise the Pod Site tracker. Allow at least one week of rest for each site.

Removal Techniques:

Advise patients to use adhesive removal agents and remove devices slowly to avoid skin tears and bruising.

Management of Reactions

For patients experiencing skin issues, you can guide them through tailored interventions:^4,9

Mild Irritation:

Suggest medium-potency topical steroids for irritant contact dermatitis. Encourage continuous use of moisturisers to restore the skin barrier.

Allergic Reactions:

Recommend switching to alternative devices or adhesives when allergies are identified. Use high-potency topical steroids for severe allergic reactions.

Persistent Issues:

In cases of ongoing reactions, patch testing can help identify specific allergens. Once the allergen is confirmed, alternative materials or devices can often resolve the issue.

Watch Out for Sensor Tape Sensitivities

Consider this Real-World Case Study Highlighting the Symptoms:

A 24-year-old woman with type 1 diabetes manages with multiple daily injections (MDI) and begins to develop redness and itching at CGM sensor sites after three years of successful use. Barrier products provide minimal relief and dermatological testing confirms sensitivity to the adhesive between the sensor and tape.

The patient switches to a different CGM brand with an alternative adhesive, resolving the issue. Six months later, she remains free of skin reactions and continues effective diabetes management without complications.

Adapted from unpublished data, Courtesy of Dr Agnes SOLA.

The Critical Role of the HCP in Patient Education

Your support is crucial in helping patients navigate the challenges of wearable diabetes technology. By promoting good skin hygiene, proper device rotation, and early detection of reactions, you can prevent minor issues from escalating. 

Collaboration with dermatologists and tools like patch testing enable personalized care, while resources like the Panther Program provide effective management strategies. Proactive education and tailored interventions empower patients to maintain healthy skin, enhancing their confidence and quality of life with these transformative devices.