Factors involved in catheter obstruction during long-term peritoneal insulin infusion.
OBJECTIVE
To analyze the efficacy of ECPII and the factors responsible for technical problems often encountered. This treatment has been in use with IDDM patients since 1980.


METHODS
Forty-four IDDM patients were treated by ECPII for 42-78 mo (mean, 53 mo).


RESULTS
Glycemic equilibrium was improved during treatment (mean plasma glucose level, 7.6 mM; mean GHb level, 8%). Catheter blockage was the main reason for ECPII failure (74%). Mean catheter survival of each catheter, determined by actuarial analysis, was 11.7 mo and significantly decreased with subsequent implantation. SEM of the catheter tips showed deposits composed of fibrin and cells occluding the inner lumen. Factors such as age, sex, local infection, and low insulin basal rate were not found to have any incidence on the catheter survival. Placement of the catheter in the upper part of the peritoneum, however, increased catheter survival. Anti-insulin antibodies did not seem to be directly involved in blockage.


CONCLUSIONS
We conclude from this long-term experience that during ECPII, catheter blockage remains the major recurring complication, probably involving a local immune-inflammatory response in the peritoneum.
Department of Metabolic and Endocrine Diseases, Faculte of Pharmacy, Lapeyronie University Hospital, Montpellier, France.
R
R
Bousquet-Rouaud
F
F
Castex
G
G
Costalat
M
M
Bastide
B
B
Hedon
M
M
Bouanani
S
S
Jouvert
J
J
Mirouze
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002408:Catheters, Indwelling; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004868:Equipment Failure; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007332:Insulin Infusion Systems; D008297:Male; D008855:Microscopy, Electron, Scanning
D001786:Blood Glucose; D006442:Glycated Hemoglobin