FACTORS INVOLVED IN CATHETER OBSTRUCTION DURING LONG-TERM PERITONEAL INSULIN INFUSION

OBJECTIVE - To analyze the efficacy of ECPII and the factors responsib le for technical problems often encountered. This treatment has been i n use with IDDM patients since 1980. RESEARCH DESIGN AND METHODS - For ty-four IDDM patients were treated by ECPII for 42-78 mo (mean, 53 mo) . RESULTS - Glycemic equilibrium was improved during treatment (mean p lasma glucose level, 7.6 mM; mean GHb level, 8%). Catheter blockage wa s the main reason for ECPII failure (74%). Mean catheter survival of e ach catheter, determined by actuarial analysis, was 11.7 mo and signif icantly decreased with subsequent implantation. SEM of the catheter ti ps showed deposits composed of fibrin and cells occluding the inner lu men. Factors such as age, sex, local infection, and low insulin basal rate were not found to have any incidence on the catheter survival. Pl acement of the catheter in the upper part of the peritoneum, however, increased catheter survival. Anti-insulin antibodies did not seem to b e directly involved in blockage. CONCLUSIONS - We conclude from this l ong-term experience that during ECPII, catheter blockage remains the m ajor recurring complication, probably involving a local immune-inflamm atory response in the peritoneum.