Glycaemic control, health status and treatment satisfaction with continuous intraperitoneal insulin infusion

Continuous intraperitoneal insulin infusion(CIPI ) has been in use for over 20 years. High costs and technical problems have prevented its widespread use. In the Netherlands, the Isala Clinics in Zwolle is the centre with the most extensive experience with CIPII . Its use is aimed at improving glycaemic control with less hypoglycaemic events, and thus improving quality of life inpatients with poorly controlled diabetes despite intensified insulin treatment. Our aim was to assess glycaemic control,health status and treatment satisfaction in subjects treated with CIPII within the Isala Clinics.

Retrospective longitudinal analysis of clinical data in 48 patients started on CIPII between 1983 and 2005.HbA1c at baseline, after one year, and at present assessment or at the end of pump use were applicable. Cross-sectional assessment of health status, well-being and treatment satisfaction was carried out.

Of 48 patients, 33 were treated with CIPII at the moment of assessment. Five patients died whilston CIPII ; four from diabetes-related causes, none from hypoglycaemia. HbA1c decreased significantly from 9.7 to 8.8% after one year, to 8.6% at long-term follow-up; p<0.01. Less hypoglycaemic events were reported. Short-Form 12-Item Health Survey (SF -12)scores were 37.4 and 47.2 (range 0-100), the Well-Being Index (WHO-5) score was 52.7 (range 0-100) and median treatment satisfaction score was 32 (range 0-36).

CIPII leads to improved glycaemic control with less self-reported hypoglycaemic events in patients with poorly controlled diabetes. Treatment satisfaction is high. Mental health status and well-being scores are low, however.