External and implantable insulin pumps: current place in the treatment of diabetes

Abstract

External insulin infusion (CSII) pumps have regained interest since DCCT, the number of patients approaching 100,000 in the USA. Only 2 manufacturers (Minimed, Disetronic) and 2 insulins (lispro, insuman) are sharing the market. The major advantages over multiple s.c. injections (MDI) are a reduction of nightly instability and hypoglycemia, and time flexibility. Patients poorly controlled under MDI and/or with recurrent hypoglycemias thus represent the best indications. Pumps are predicted to expand in some european countries e.g. France with changes in reimbursement regulations. Implantable insulin pumps are still not commercialized except in few countries e.g. France. Therefore only 1065 pumps have been implanted worldwide so far. The only material available is the Minimed 2007 pump, with the Aventis Genapol insulin. The catheter is intraperitoneal for portal insulin absorption. Metabolic results are better than CSII in terms of glycemic fluctuations and hypoglycemias. Adverse events are limited to catheter obstructions (15% per patient-year). Ideally, indications should be restricted only to patients with recurrent severe hypoglycemias and/or poor control with CSII because of high cost of the pump ($ 15,000).

Treg cells in pancreatic lymph nodes: the possible role in diabetogenesis and β cell regeneration in a T1D model

“…The major milestones in solving the problem of insulin deficiency are: (i) the discovery of insulin; 1,2 (ii) pancreata and islets of Langerhans transplantation; 3,4 and (iii) development of insulin-supplying devices. 5,6 All of these contribute to symptomatic therapies that restore the insulin deficiency.…”

Human insulin production and amelioration of diabetes in mice by electrotransfer-enhanced plasmid DNA gene transfer to the skeletal muscle

“…4 However, problems related to management, acceptability and costs further reduce the use of this kind of treatment. [5][6][7] Correspondence: S Martinenghi, Alternative therapeutic approaches based on allogenic transplantation are indeed a clinical option, but only in selected cases. Pancreas transplantation is able to completely normalize glucose metabolism, but is a major surgical procedure and requires permanent immunosuppression, 8 which is associated with increased risk of cancer 9 and infections.…”

Disruptive visions: Biosurgery

“…Most prostheses implanted today are large, such as cardiac pacemakers and valves, hip or knee joints, or glucose infusion pumps (for diabetes) [5]. However there are reports of implanting microchips and microarrays into the retina (artificial retina) [3] or brain (for control of robotic arms) [6] of animals.…”