Cope JU et al. (2008) Adolescent use of insulin and patient-controlled analgesia pump technology: a 10-year Food and Drug Administration retrospective study of adverse events. Pediatrics 121: e1133–e1138

Insulin pumps and patient-controlled analgesia (PCA) pumps are increasingly used by children and adolescents. Although these devices offer effective control of blood glucose level and pain, the growing number of adverse event reports has raised concerns about their safety in adolescents. Cope and colleagues performed a retrospective study of adverse events reported to the Food and Drug Administration between 1996 and 2005 that involved patients aged 12–21 years.

In total, 1,594 insulin-pump-related adverse events were reported, including 1,038 injuries and 13 deaths. In 82% of cases the patient required hospital admission. The most common adverse events were hyperglycemia (61.9%), and hypoglycemia or overdelivery of insulin (10.5%). Issues specific to adolescents were identified in 6.4% of the reports, including problems with education and adherence, risk-taking behavior (including suicide attempts in two cases), and sport-related activities. The 53 reports of PCA-pump problems included 19 injuries and 5 deaths. Overmedication was cited in 27 reports, which in 12 cases led to respiratory depression and unresponsiveness. In two cases the adverse events were probably caused by tampering with the device.

The authors conclude that the use of insulin and PCA pumps might be problematic in teenagers because of lifestyle and psychosocial factors. They emphasize the importance of education, careful selection, and monitoring of adolescents who use these devices.