External and implantable insulin pumps: current place in the treatment of diabetes

External insulin infusion (CSII) pumps have regained interest since DCCT, t he number of patients approaching 100,000 in the USA. Only 2 manufacturers (Minimed, Disetronic) and 2 insulins (lispro, insuman) are sharing the mark et. The major advantages over multiple SC injections (MDI) are a reduction of nightly instability and hypoglycemia, and time flexibility. Patients poo rly controlled under MDI and/or with recurrent hypoglycemias thus represent the best indications. Pumps are predicted to expand in some european count ries e. g. France with changes in reimbursement regulations. Implantable in sulin pumps are still not commercialized except in few countries e.g. Franc e. Therefore only 1065 pumps have been implanted worldwide so far. The only material available is the Minimed 2007 pump, with the Aventis Genapol insu lin. The catheter is intraperitoneal for portal insulin absorption. Metabol ic results are better than CSII in terms of glycemic fluctuations and hypog lycemias. Adverse events are limited to catheter obstructions (15% per pati ent-year). Ideally, indications should be restricted only to patients with recurrent severe hypoglycemias and/or poor control with CSII because of hig h cost of the pump ($ 15,000).