Overcoming skin barriers to CGM and FGM

Friday, 25 September 2020

Use of continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) is becoming the standard of care for people with type 1 diabetes.

However, it’s reported about 20 percent of users discontinue using their device due to skin complications1.

Issues with skin irritation and skin complications need to be addressed as this can become a barrier and a reason why people discontinue using these glucose monitoring devices.

What are the issues?

The number of users that experience some form of skin issues because of CGM and FGM use has been reported in studies as 60 percentto 80 percent2 of paediatric and young adult users. In adults, one in three adults presents with skin issues when using CGM and FGM3.

Issues raised amongst users of CGM and FGM include:

  • Poor adhesion – due to the sensor not staying stuck on due to swimming, living in humid conditions, sweating and being an athlete2.
  • Skin reactions from adhesives – reactions often include itchy skin, eczema and wounds2.
  • Skin reactions from the filament or small canula inserted.

Preparing skin for good adhesion

Correct preparation of the insertion site for the sensor is important to achieve good adhesion of the device. This includes:

  • washing hands and the site with soap and water;
  • trimming hair at the site;
  • not applying lotions to the site where the sensor will be inserted;
  • and preparing the area with an alcohol wipe. Allow the area to cool and dry before inserting the sensor2,4,5.

When applying any skin preparation solution to the skin, it should be applied in a donut formation (a circle with a hole in the middle) leaving a small circle bare at the centre of the skin so you can insert the sensor only through skin that has been prepped with alcohol.

Antiperspirant (non-deodorant)

To prepare the skin for application of a CGM or FGM, some studies have reported the use of solid or sprayed antiperspirant when there is an issue with excessive sweating and poor adhesion2.

The antiperspirant is applied in a thin layer to the skin, waiting 10 to 15 minutes, then wiping away any excess and prepare the site for sensor application2,4,5.

Barriers, Adhesives and Tackifiers

Products to protect the skin from irritation once the sensor is inserted include liquid barriers which are wiped on or sprayed on and allowed to dry.

Some products may enhance adhesion of the sensor to the skin by making the skin tacky2,5. Liquid barriers and products available in Australia are:

  • IV Prep Wipes
  • Cavilon Barrier Wipes
  • Convacare Barrier Wipes
  • Matisol Liquid Adhesive

Always apply using a donut formation (a circle with a hole in the middle) and allow the liquid product to dry before insertion of the sensor.

Barrier Film

Barrier patches are a thin film or tape that are applied to the skin and under the sensor2.

This provides the skin with a protective barrier from the sensor adhesive.

It’s recommended to leave a hole in the barrier film where the sensor canula or filament will penetrate the skin2.

These same products may be applied over the sensor to keep the sensor in place, allowing a hole for the transmitter2.

Such barrier films available include:

  • Tegaderm HP Film
  • Fixomull stretch tape
  • IV3000
  • Opsite Flexifix
  • Rocktape

Use of barrier patches between the skin and the sensor may not have been tested by manufacturers of your CGM and FGM. Contact your manufacturer or health care team if the use of barrier films are appropriate for you and your device.  

Adhesive Removers

Removal of the sensor adhesive or barrier film is recommended in a “low and slow” approach2. This requires removing the adhesive slowly, at a low angle and folding it back on itself.

Adhesive remover wipes are applied on the adhesive and rubbed under the skin towards the adhesive (as it is gently lifted) to aid with removal of the film2. Adhesive removers available include:

  • Uni-Solve Adhesive Remover Wipes
  • Detachol Adhesive Remover
  • Household oils such as olive oil or baby oil.

Skin Hypersensitivity

Addressing skin hypersensitivity is one of the biggest challenges to help maintain the integrity of skin while wearing CGM and FGM devices.

Topical corticosteroids creams and sprays are used to address this issue. Use of such creams are not recommended under sensors or barrier film.

Topical corticosteroids creams are used to reduce inflammation and itch of unbroken skin, and have been reported to improve the skin in 77% of CGM users1

A product that is being researched in this use is off-label steroid nasal spray containing fluticasone, with the puff/spray applied to the skin and allowed to dry prior to application of any barrier film or the sensor adhesive2.

Use of nasal sprays topically is currently acknowledge by one study as a way that users of CGM and FGM are protecting the skin from adverse effects2.

However, long term use of these nasal sprays is off-label and it’s currently unknown if there are any risks with long-term application on the skin.

Where to from here?

Remember, everyone’s skin type is different and users of CGM and FGM need to trial products to find one suitable to your needs.

When inserting your sensor, the filament or canula should only be inserted through clean dry skin which has been prepped with an alcohol wipe.

If you are having issues with your sensor sites and skin irritations, talk to your health care team or the manufacturer of your device to find suitable solutions for your circumstance.

References

  1. Severin RK, Gandica R, Levin LE, Belsito DV, Garzon, MC, Williams KM. Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes. Diabetes Jul 2018, 67 (Supplement 1) 1591-P; DOI: 10.2337/db18-1591-P
  2. Messer LH, Berget C, Beatson C, Polsky S, Forlenza GP. Preserving Skin Integrity with Chronic Device Use in Diabetes.Diabetes Technol Ther. 2018;20(S2):S254-S264. doi:10.1089/dia.2018.0080
  3. Asarani NAM, Reynolds AN, Boucher SE, de Bock M, Wheeler BJ. Cutaneous Complications with Continuous or Flash Glucose Monitoring Use: Systematic Review of Trials and Observational Studies.J Diabetes Sci Technol. 2020 Mar;14(2):328-337. doi: 10.1177/1932296819870849. Epub 2019 Aug 27. PMID: 31452386
  4. 2019. Tape tips and site management. Retrieved: https://www.medtronicdiabetes.com/sites/default/files/library/download-library/workbooks/Tape%20Tips%20and%20Site%20Management.pdf{26/6/2020}
  5. 2020. How can I avoid irritated or sensitive skin caused by the Dexcom sensor adhesive? Retrieved from https://www.dexcom.com/faqs/sensitive-skin{26/6/2020}

Article by Alison Crow

Pharmacist CDE

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