Intraperitoneal insulin infusion versus islet transplantation: comparative study in patients with type 1 diabetes.
OBJECTIVE
The purpose of this article was to compare two strategies for insulin delivery in brittle type 1 diabetic patients: intraperitoneal insulin infusion (IPII) through an implantable pump and intraportal islet transplantation (IIT).


METHODS
Thirteen consecutive patients (6 islet after kidney and 7 islet transplantation alone), treated with IIT according to the Edmonton protocol, were compared with 17 patients treated with IPII in the same center in a nonrandomized study. Both groups of patients were assessed for clinical profile, metabolic results, and adverse events during the 3-year period after implantation.


RESULTS
Sex ratio, mean age, body mass index, diabetes duration, daily insulin need (DIN), blood creatinine, lipid and HbA1c levels, and frequency of diabetic complications did not differ significantly between the two groups before inclusion. The comparison of metabolic results 3, 6, and 12 months after IIT or IPII showed that while mean HbA1c significantly decreased over time in both groups, mean DIN, glycemia, and number of hypoglycemias less than 3.3 mmol/L per patient per week (Hypo) only significantly decreased in the IIT group versus baseline. At 12 months, mean DIN, HbA1c, and Hypo were significantly lower in the IIT versus IPII group. After 24 and 36 months, mean DIN, HbA1c, and Hypo remained significantly lower in the IIT group versus baseline, and mean HbA1c and DIN versus IPII. Adverse events were, however, fourfold more frequent with IIT versus IPII, though their numbers decreased over time.


CONCLUSIONS
These results suggest that metabolic results improve with both methods, but were significantly better with IIT versus IPII, though with more frequent side effects.
Vantyghem
Marie-Christine
MC
INSERM U 859, Diabetes Cell Therapy Lille University Hospital, Lille Cedex, France. mc-vantyghem@chru-lille.fr
Marcelli-Tourvieille
Sophie
S
Fermon
Catherine
C
Duhamel
Alain
A
Raverdy
Violetta
V
Arnalsteen
Laurent
L
Kerr-Conte
Julie
J
Noel
Christian
C
Fontaine
Pierre
P
Pattou
François
F
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007263:Infusions, Parenteral; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects; D008297:Male
D007328:Insulin