Implantable insulin pumps: a major piece of computerized diabetes therapy

There is a significant need for revised, safe and more effective insulin delivery methods than subcutaneous insulin therapy, including CSII, in the treatment of type 1 diabetes. The aim of the review is to describe the current status, issues and prospects of insulin therapy with implantable insulin pumps. The International Registry of Human Implantation reports that, as of May 1988, 249 pumps have been implanted, using the intravenous or intraperitoneal route for insulin infusion. The data suggest a reasonable safety of the method, no pump run-away having been reported and only one patient having died of severe hypoglycemia possibly related to the pump. The more recent European (POINT) and U.S. (PIMS) trials with programmable pumps have confirmed the safety and suggested a better efficacy of the method over subcutaneous insulin administration. They also have pointed out that in order to represent an acceptable alternative to existing methods, implantable pumps still have to a) cope with or increase catheter longevity, presently of 2-3 years only, namely by improving catheter biocompatibility and b) clearly prove its superiority over subcutaneous methods at controlling diabetes, using large-scale, randomized, prospective controlled studies.