1,6-Hexanediol Diacrylate, Isocyanates and Other Skin Sensitizers Are Emerging Contact Allergens in Guardian Glucose Sensors

Abstract

Background: Allergic contact dermatitis (ACD) from diabetes devices remains a significant concern. Objective: To report ACD from Guardian 3 and 4 glucose sensors (G3/4 sensors) due to multiple skin sensitizers, that is, isobornyl acrylate (IBOA), N,N-dimethylacrylamide (DMAA) and also 1,6-hexanediol diacrylate (HDDA), isocyanates, colophonium derivatives, tert-butylphenols (TBPs) and salicylates. Methods: Twenty-seven patients with ACD from G3/4 sensors, evaluated between January 2020 and December 2024, were patch-tested to a baseline, acrylate, isocyanate and plastics and glue series. The sensors and their overtape (Oval Tape) were analysed with gas chromatography–mass spectrometry (GC-MS). Results: Most patients (44%) reacted to colophonium (derivatives), followed by IBOA (31%) and isocyanates (29%). Fewer, yet remarkable reactions were observed to HDDA (20%), TBPs (12.5%) and DMAA (8%). All IBOA and DMAA-allergic patients had been previously sensitised by the FreeStyle I sensor, whereas patients using G3/4 sensors as their first diabetes device were not sensitised to these two allergens. Chemical analyses confirmed the presence of colophonium derivatives, IBOA, DMAA, HDDA, isocyanates, TBPs and, interestingly, also salicylates, as skin sensitizers in these sensors. Conclusions: The newer glucose sensors Guardian 3 and 4 contain, besides IBOA and DMAA, also HDDA, together with a multitude of other skin sensitizers that put patients at risk of developing ACD.