Experience with intraperitoneal insulin infusion from implantable programmable systems in type 1 (insulin-dependent) diabetes mellitus previously treated by external pumps.
The feasibility of the continuous intraperitoneal insulin infusion from implantable programmable systems was evaluated in 17 Type 1 (insulin-dependent) diabetic patients currently treated by external pumps. Eight subjects were using a continuous subcutaneous insulin infusion (cumulated experience: 7.4 patients x years) and nine subjects had a cumulated experience of 61.4 patients x years of continuous intra peritoneal insulin delivery by external pumps. The two studied implantable systems (A and B) were delivering the same pH neutral surfactant-stabilized semi-synthetic human insulin, but at the respective concentrations of 400 units per ml in group A (n = 12) and of 100 units per ml in group B (n = 5), via a peritoneal catheter. The pump was implanted in a subcutaneous pocket created in the abdominal wall under general anesthesia. The reported trial of implantable programmable systems is 21 patient x years with an individual experience of 1.2 +/- 0.4 years (mean +/- SD). A sustained and stable glycaemic control was obtained, as indicated by the haemoglobin A1c: 7.4 +/- 1.3% (normal range: 4.3-6.1%), the mean blood glucose: 7.4 +/- 2.1 mM.l-1, the standard deviation of blood glucose values: 3.4 +/- 0.4 mM.l-1 and the percentages of 13.1 +/- 4.5% and 6.1 +/- 6.1% of blood glucose values respectively over 11 mM.l-1 and under 2.8 mM.l-1 after one year. The only metabolic event to occur was one episode of ketoacidosis secondary to a catheter obstruction. No hypoglycaemic coma occurred contrasting with incidences of 0.54 and 0.05 per patient x year during subcutaneous external and intraperitoneal pumps respectively (p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Renard
E
E
Service d'Endocrinologie, Hôpital Lapeyronie, Montpellier, France.
Lauton
D
D
Bonifacj
C
C
Costalat
G
G
Jacques
D
D
Bringer
J
J
Jaffiol
C
C
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003128:Coma / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D004867:Equipment Design; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D015994:Incidence; D007332:Insulin Infusion Systems / Q000009:adverse effects; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D006442:Glycated Hemoglobin