title: Finding the right route for insulin delivery - an overview of implantable pump therapy.
abstract: Implantable pump therapy adopting the intraperitoneal route of insulin delivery has been available for the past three decades. The key rationale for implantable pump therapy is the restoration of the portal-peripheral insulin gradient of the normal physiology. Uptake in clinical practice is limited to specialized centers and selected patient populations. Areas covered: Implantable pump therapy is discussed, including technical aspects, rationale for its use, and glycemic and non-glycemic effects. Target populations, summaries of clinical studies and issues related to implantable pump therapy are highlighted. Limitations of implantable pump therapy and its future outlook in clinical practice are presented. Expert opinion: Although intraperitoneal insulin delivery appears closer to the normal physiology, technical, pharmacological, and costs barriers prevent a wider adoption. Evidence from clinical studies remains scarce and inconclusive. As a consequence, the use of implantable pump therapy will be confined to a small population unless considerable technological progress is made and well-conducted studies can demonstrate glycemic and/or non-glycemic benefits justifying wider application.
authors.affiliation: a Wellcome Trust-MRC Institute of Metabolic Science , University of Cambridge , Cambridge , UK.|b Department of Diabetes & Endocrinology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK.|c Department of Diabetes, Endocrinology, Clinical Nutrition & Metabolism, Inselspital , Bern University Hospital, University of Bern , Bern , Switzerland.
authors.forename: Lia
authors.initials: L
authors.lastname: Bally
authors.affiliation: a Wellcome Trust-MRC Institute of Metabolic Science , University of Cambridge , Cambridge , UK.|b Department of Diabetes & Endocrinology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK.
authors.forename: Hood
authors.initials: H
authors.lastname: Thabit
authors.affiliation: a Wellcome Trust-MRC Institute of Metabolic Science , University of Cambridge , Cambridge , UK.|d Department of Paediatrics , University of Cambridge , Cambridge , UK.
authors.forename: Roman
authors.identifier: 0000-0003-2901-461X
authors.initials: R
authors.lastname: Hovorka
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000187:drug effects; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015918:Infusion Pumps, Implantable; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D019397:Pancreas, Artificial
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Type 1 diabetes; diabetes technology; implantable pump; intraperitoneal insulin delivery