EXPERIENCE WITH INTRAPERITONEAL INSULIN INFUSION FROM IMPLANTABLE PROGRAMMABLE SYSTEMS IN TYPE-1 (INSULIN-DEPENDENT) DIABETES-MELLITUS PREVIOUSLY TREATED BY EXTERNAL PUMPS
E. Renard et al., EXPERIENCE WITH INTRAPERITONEAL INSULIN INFUSION FROM IMPLANTABLE PROGRAMMABLE SYSTEMS IN TYPE-1 (INSULIN-DEPENDENT) DIABETES-MELLITUS PREVIOUSLY TREATED BY EXTERNAL PUMPS, Diabete et metabolisme, 19(4), 1993, pp. 364-371
The feasibility of the continuous intraperitoneal insulin infusion fro
m implantable programmable systems was evaluated in 17 Type 1 (insulin
-dependent) diabetic patients currently treated by external pumps. Eig
ht subjects were using a continuous subcutaneous insulin infusion (cum
ulated experience: 7.4 patients x years) and nine subjects had a cumul
ated experience of 61.4 patients x years of continuous intra peritonea
l insulin delivery by external pumps. The two studied implantable syst
ems (A and B) were delivering the same pH neutral surfactant-stabilize
d semi-synthetic human insulin, but at the respective concentrations o
f 400 units per mi in groupe A (n = 12) and of 100 units per mi in gro
upe B (n = 5), via a peritoneal catheter. The pump was implanted in a
subcutaneous pocket created in the abdominal wall under general anesth
esia. The reported trial of implantable programmable systems is 21 pat
ient x years with an individual experience of 1.2 +/- 0.4 years (mean
+/- SD). A sustained and stable glycaemic control was obtained, as ind
icated by the haemoglobin Alc: 7.4 +/- 1.3 % (normal range: 4.3-6.1 %)
, the mean blood glucose: 7.4 +/- 2.1 mM.1(-1), the standard deviation
of blood glucose values: 3.4 +/- 0.4 mM.1(-l) and the percentages of
13.1 +/- 4.5 % and 6.1 +/- 6.1 % of blood glucose values respectively
over 11 mM.1(-1) and under 2.8 mM.1(-l) after one year. The only metab
olic event to occur was one episode of ketoacidosis secondary to a cat
heter obstruction. No hypoglycaemic coma occurred contrasting with inc
idences of 0.54 and 0.05 per patient x year during subcutaneous extern
al and intraperitoneal pumps respectively (p < 0.02). Minor problems w
ere one post-surgical regressive haematoma of the pump pocket in group
A, five reversible slowdowns of the pump flow-rate in groupe B and oc
casional non complicated defects of the pump communicator in both grou
ps. Five patients, all under previous external intraperitoneal pumps,
experienced irreversible obstructions of the peritoneal catheter, incl
uding a double recurrence in one subject leading to the removal of the
implanted system. The incidence of catheter obstructions was thus nul
l for the patients under previous subcutaneous insulin infusion, but 0
.58 per patient x year for those under previous external intraperitone
al systems (p < 0.03). We conclude that, although perfectible, the imp
lantable programmable system is a reliable technique which provides in
creased safety for Type 1 diabetic patients who are candidates for int
ensive continuous insulin therapy. A peritoneal history of insulin del
ivery appears however to significantly affect the life expectancy of t
he catheter.