Intraperitoneal delivery of insulin via mechanical pump: surgical implications

Abstract

Between November 1986 and January 2000, 28 patients with insulin-dependent diabetes mellitus were enrolled in the implanted insulin pump study at Johns Hopkins Hospital. An additional two patients underwent pump implantation under compassionate use guidelines due to apparent resistance to subcutaneously administered insulin uptake. The mean patient age was 44 +/- 10.5 years. Eleven patients (39%) were female and the mean duration of diabetes was 25.7 +/- 8.9 years. Diabetic retinopathy, neuropathy, and nephropathy were present in 43%, 25% and 11 % of patients, respectively. The insulin pumps functioned safely for a total of 189 patient years. Mean pump life was 26 +/- 1.2 months. There was no mortality. Morbidity was limited to pump-site infections [n=y (4%) of all pumps placed], one case of pump migration and skin erosion, and one small bowel obstruction associated with the pump catheter. Mean serum hemoglobin AIC levels before and after pump placement were 9.0 +/- 2.9% and 7.5 +/- 0.7% (P=0.0023), respectively. Correspondingly, the mean daily blood glucose levels decreased from l61 +/- 40 mg/dl before placement to 141 +/- 27 mg/dl after pump placement (P=0.0063). Intraperitoneal delivery of insulin by a mechanical pump appears to be an attractive alternative for the treatment of insulin-dependent diabetes mellitus.

Surgical aspects and complications of continuous intraperitoneal insulin infusion with an implantable pump

“…Our current report shows that despite the requirement of re-intervention surgery during followup, CIPII is safe, without pump or operation-related mortality and with a low complication rate. More than 80% of our patients has not experienced any pump-related complications and our pump-site infection rate of 2.4 per 100 patient-years is comparable with that in literature [10,12,13]. This infection rate was higher in the patients operated in or after 2000 (1 in 73.5 versus 1 in 17.4 patientyears).…”

“…Udelsman et al reported regarding 21 patients started on CIPII between 1986 and 1991 in an American centre needing one surgical re-intervention per 1.7 patient-years without occurrence of mortality [9]. This group published an update in 2000 reporting the same rate of reinterventions in 28 subjects [10]. At the time of these reports, the pump battery lasted approximately 2.5 years and many reinterventions were needed because of the necessity of pump replacement after battery depletion [9].…”

Biocompatibility of nanoporous alumina membranes for immunoisolation

“…Numerous studies have shown that the intraperitoneal space is the implantation site of choice for devices treating diabetes, because insulin delivered in this way more closely resembles the body's natural physiology, with the insulin being taken up by the portal system and preferentially absorbed by the liver [38,39]. Additionally, portal insulin absorption achieves faster plasma kinetics and greater reproducibility than other delivery routes such as subcutaneous injection.…”

The role of capsule composition and biologic responses in the function of transplanted microencapsulated islets of langerhans1

“…Another disadvantage of the peritoneal cavity is the large number of macrophages present (20), which is the most common cell type in the host response to capsules (21). In addition, the peritoneal cavity is not the physiologic route for insulin delivery, although studies using insulin pumps have shown that blood glucose concentrations are lowered by intraperitoneal delivery of insulin (22). It is therefore not surprising that an increased islet mass is required to reverse hyperglycemia when islets are transplanted intraperitoneally (23).…”