What do I do if someone is having issues with the adhesive for a Continuous Glucose Monitor (CGM)?

Managing Adhesive Issues with Continuous Glucose Monitors (CGMs)

For patients experiencing adhesive issues with CGMs, use skin barrier products and consider alternative adhesive options to maintain sensor adherence while minimizing skin reactions. 1

Understanding CGM Adhesive Problems

Contact dermatitis (both irritant and allergic) is a common issue reported with all CGM devices that attach to the skin 1. These reactions can significantly impact patient comfort and adherence to CGM therapy, with skin reactions reported in approximately 28% of CGM users 2.

Types of Skin Reactions

• Redness and pruritus (70-75% of reactions)
• Pain (20-25% of reactions)
• Vesicles and desquamation (12-15% of reactions) 2

Step-by-Step Management Approach

1. Identify the Cause

• Irritant Contact Dermatitis: More common, develops from mechanical or chemical irritation
• Allergic Contact Dermatitis: Can be linked to specific components like isobornyl acrylate, a known skin sensitizer 1

2. Preventive Strategies

• Proper Skin Preparation:

  • Clean the application site with mild soap and water
  • Ensure skin is completely dry before application
  • Avoid alcohol-based products that can dry and irritate the skin

• Skin Barrier Products:

  • Apply hydrocolloid-based plasters underneath the sensor 3
  • Use skin barrier wipes or films before sensor application

3. Adhesive Enhancement Options

• For sensors that don't stick well:
  • Apply additional medical-grade adhesive tape over the sensor
  • Consider supplemental adhesive products specifically designed for CGM devices 4
  • Try different locations with less movement and friction

4. Management of Existing Reactions

• For mild irritation:

  • Rotate insertion sites to allow skin healing
  • Apply over-the-counter hydrocortisone after sensor removal

• For severe reactions:

  • Consider hydrocolloid-based plasters as a barrier between skin and sensor 3
  • All patients with allergic contact dermatitis in one study were able to continue CGM use with appropriate barrier plasters 3

Special Considerations

Environmental Factors

• Ambient temperature, humidity, and physical activity can affect adhesion 4
• In hot, humid conditions or during intense exercise, more frequent site changes may be needed

Pediatric Patients

• Limited body surface area in smaller children requires careful site rotation 4
• Children may need additional adhesive products to maintain sensor placement during physical activity

When to Seek Medical Help

If skin reactions are severe or persistent:

• Patch testing can help identify specific allergens 1
• A healthcare provider may recommend alternative CGM systems with different adhesive formulations
• In rare cases (approximately 3.2% of all users), severe reactions may require discontinuation of the specific CGM device 2

Manufacturer Resources

Many CGM manufacturers offer specific guidance and free adhesive overlay patches for users experiencing issues. The Panther Program (pantherprogram.org/skin-solutions) provides resources in both English and Spanish for managing skin issues related to diabetes devices 1.

Remember that finding the right solution may involve trial and error with different supplemental products or combinations of products 4. With proper management, most patients can continue to benefit from CGM technology despite adhesive challenges.