[Implantable insulin pumps: evaluation after more than 3 years experience]

Since the beginning of insulin therapy the improvement of treatment in IDDM is mainly for acute metabolic complications than for chronic degenerative complications. The DCCT could recently prove for the first time that the incidence of chronic complications (retinopathy, nephropathy and neuropathy) could be diminished by reaching glycemic control in more than 700 patients. One of the problems explaining the failure of classical treatment is due to the variability of absorption in the sub-cutaneous tissue. The patients treated by insulin pumps are all IDDM. The aim of this study is to evaluate safety and feasibility of implantable programmable pumps with intraperitoneal insulin infusion. We found three cases of irreversible catheter obstruction. Defects of external communicators and the slow-downs of insulin infusion in infusaid pumps were observed. No acceleration in insulin infusion was found. Acute metabolic complications were two severe hypoglycemic events, but no acito-cetosis. After more than two years for most of the patients we observed a global improvement in glycemic control, demonstrated by a better mean glycemia and lower HbA1c values. The standard deviation of the glycemia was lowered significantly, this value reflects daily fluctuability. The number of hypoglycemias was also lowered. Our study shows a more stable glycemic control than the one in the DCCT study. The safety and feasibility seem to be highly satisfying.