Supplementary Material for: SKIN-PEDIC – a worldwide assessment of skin problems in children and adolescents using diabetes devices

Introduction: Children and adolescents with diabetes are increasingly using technological devices to maintain normoglycemia. However, skin problems associated with these devices are becoming a significant issue. This study aimed to investigate prevalence of skin issues in children and adoles-cents with diabetes globally and identify important factors associated with these skin problems. Methods: This multinational study involved 22 pediatric diabetes centers. Over a 4-week period, pseud anonymized data were collected on children and adolescents using diabetes devices, includ-ing demographic factors, visual skin problems, type of devices and products being used. Uni-variate logistic regression was applied to identify associations with skin problems. Results: A total of 1719 children and adolescents were included. Skin problems were present in 52% of pump users compared to 30% of sensor users. Eczema was found in 9% of participants at both insulin pump and glucose sensor sites, whereas scars, wounds and lipodystrophies were significant-ly more frequent at insulin pump sites than at glucose sensor sites. Skin characteristicsBoth xerosis cutis and keratosis pilaris were strongly associated with almost all types of skin problems, increasing the risk two to fivefold. Conclusion: Skin problems are a serious concern that limits the use of diabetes devices in children and adolescents, consequently increasing risk for long-term complications. This study highlights the extent of the problem in a real-world setting of unselected participants despite the use of preven-tive strategies. Consequently, the development of more skin-friendly devices is needed to ensure that all children and adolescents with diabetes can effectively use these devices in the long term.引言：糖尿病儿童与青少年正越来越多地借助各类科技设备维持血糖正常水平。然而，与这些设备相关的皮肤问题正成为一项亟待关注的重要临床问题。本研究旨在全球范围内调研糖尿病儿童与青少年的相关皮肤问题患病率，并明确与这类皮肤问题相关的关键影响因素。 方法：本跨国研究共纳入22家儿童糖尿病诊疗中心。研究周期为4周，针对使用糖尿病诊疗设备的儿童与青少年收集伪匿名化（pseudonymized）数据，内容涵盖人口统计学特征、肉眼可见的皮肤异常情况、所用设备及产品类型。采用单变量logistic回归（logistic regression）分析，探究与皮肤问题相关的关联因素。 结果：本研究最终纳入1719名儿童与青少年受试者。胰岛素泵（insulin pump）使用者的皮肤问题发生率为52%，而血糖传感器（glucose sensor）使用者的发生率为30%。9%的受试者在胰岛素泵及血糖传感器的佩戴部位均出现湿疹（eczema）；而瘢痕（scars）、伤口（wounds）及脂肪营养不良（lipodystrophies）在胰岛素泵佩戴部位的发生率显著高于血糖传感器佩戴部位。皮肤特征层面：皮肤干燥症（xerosis cutis）与毛周角化病（keratosis pilaris）均与几乎所有类型的皮肤问题存在强相关性，可使患病风险提升2至5倍。 结论：皮肤问题已成为限制糖尿病儿童与青少年使用诊疗设备的严重隐患，进而增加了远期并发症的发生风险。本研究揭示了在未经过入组筛选的真实世界队列中，即便采取了预防策略，该类皮肤问题的发生规模仍不容小觑。因此，亟需研发更具皮肤友好性的糖尿病诊疗设备，以保障所有糖尿病儿童与青少年能够长期安全有效地使用此类设备。