Ultrasound-Guided Infusion Site Rotation Improves Glycemic Outcomes in Children and Adolescent Users of Automated Insulin Delivery Systems
Authors' conclusion
TIR declines from day 2 of infusion set wear despite rising insulin doses, indicating reduced absorption not fully compensated by AID. Ultrasound-guided site selection improves glycemic outcomes, likely by supporting more consistent and effective site rotation.
Study context
- Population
- Children and adolescents (6–18 years) using automated insulin delivery (AID); mean age 11.3 years, diabetes duration 5.6 years, 55% male, HbA1c 54 mmol/L [7.1%]31 with sufficient CGM data
- Participants
- 40 children
- Exposure
- Ultrasound-only tissue changes vs Ultrasound and clinical signs
- Outcome
- TIR and insulin dose/kg/day by days since infusion set change
Methodological details28-day, ultrasound-guided site rotation
- 28-day
- Ultrasound-guided site rotation
Main finding
As reported in the abstract
TIR by days since infusion set change, after guiding
Time in range (TIR) increase for 2 days post set change
2.5% points/day
P < 0.0001
TIR decrease thereafter
4.7% points/day
P < 0.0001
Insulin dose rise after day 2
0.036 U/kg/day
P = 0.009
Observational data: associations, not effects.
Further findings
TIR by tissue change type
P < 0.0001
Hyperechogenicity (early lipohypertrophy)
- Correlation with clinical lipohypertrophy
- risk ratio = 3.63 (P < 0.001)
- Hyperechogenicity associated with lower TIR after day 2
Original publication
Ultrasound-Guided Infusion Site Rotation Improves Glycemic Outcomes in Children and Adolescent Users of Automated Insulin Delivery Systems. Diabetes Technol Ther. Published 19 March 2026. doi:10.
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