[Implantable insulin pump: the first step towards an artificial pancreas]

Recent improvements in miniaturization of implantable pumps and the ability of their control by teletransmission allow implantation of autonomous pumps which administer insulin into the peritoneal cavity. Fifty-six patients with diabetes mellitus underwent implantation of 66 pumps with a mean function life of 21.8 months per patient. No patient has died to date. Tolerance of implanted components was good. Morbidity was limited to local events, in this series 4 cutaneous erosions, two of them leading to final pump explantation. Mean global blood-sugar, pre- and post-prandial blood-sugar, and glycosylated hemoglobin assays were all lower versus pre-implantation assays. A statistically significant difference was demonstrated regarding mean global blood-sugar. The frequency of severe hypoglycemia incidents (2 in our series) and biochemical hypoglycemia (blood-sugar < 65 mg/100 ml) was decreased, representing a major benefit of the technique. The patients well-being and quality of life were notably improved. Implantable insulin-pump may be offered as alternative treatment to conventional insulin-therapy, especially in cases of diabetes which are difficult to control and particularly in cases with frequent hypoglycemic malaise.