[Treatment of insulin-dependent diabetes: new therapy by electromagnetic replacement: towards an artificial pancreas]

The goal of treatment of diabetes mellitus is the achievement of sustained normoglycemia to prevent the complications with the lowest incidence of hypoglycemia. In the same time, it attempts to reduce the hourly and daily constraints due to multiple injections and self monitoring of glycemia. Both intermittent injections and subcutaneous route are inappropriated to extreme precision and flexibility of regulation requested to reach optimal glycemic control and the best quality of life in most diabetic people. The progress in biomaterials and micro-electronics, the availability of stable insulin solutions have permitted to implant a pump with an awaited functional autonomy for 10 years and to perfuse insulin by peritoneal way in a continuous and modulable fashion. The intra-vascular implanted enzymatic glucose sensors, using glucose-oxidase, are able to measure with good accuracy real-time blood glucose for the duration from 6 to 12 months. The combination of these two linked devices implanted in type 1 diabetic patients has given the opportunity to perform the first trials for periods of 48 hours delivering automated insulin according to glycemic variability. This most physiological restoration of insulin function is feasible and appears to represent a possibility for long term treatment of diabetics.