Endocrine Abstracts

The National Institute for Health and Care Excellence (NICE) recommends continuous glucose monitoring devices (CGMDs) for all adults and children with Type 1 diabetes mellitus (T1DM). Automated technologies such as hybrid closed loop (HCL) systems can improve outcomes and quality of life for patients, their families and carers. There have been increasing reports of cutaneous allergic reactions to medical devices, including CGMDs, in the literature. These reactions are mostly to the sensor of the CGMD, which is held in place on the skin with adhesive. The commonest allergens identified in these devices are the acrylates. Identifying allergens in medical devices is a major problem and is not a legal requirement of manufacturers. This complicates the identification and patch testing of potential allergens making it difficult to recommend an alternative device. Should allergic contact dermatitis (ACD) develop, individuals may have to stop CGMDs with a negative impact on quality of life and diabetes control. We report two cases of ACD to CGMD sensors in children with T1DM, who were using HCL system, where the skin reaction was prevented by the placement of a solid hydrocolloid barrier between the adhesive on the sensor and the skin. A child aged 14 developed a reaction to HCL, Medtronic 640G. She had previously used the Freestyle Libre 1 but discontinued use after 10 months due to severe ACD. Three months after use of the Medtronic Guardian sensor she developed ACD, patch testing was performed and was positive to isobornyl acrylate. A second child, developed ACD to Dexcom G6, having used it for several years, this coincided with a change in the manufacturing process. In both cases placement of the barrier (Compeed) prevented any further ACD. This method has helped to maintain excellent diabetes control (table 1) with no adverse impact on sensor function. This method is now used routinely when ACD arises from Dexcom G6 CGMD in our service allowing on-going use of HCL system. We highlight two cases where barrier use has allowed continued quality of life and excellent diabetic control.Table 1