Systematic review: continuous intraperitoneal insulin infusion with implantable insulin pumps for diabetes mellitus

Abstract

complications of diabetes and treatment satisfaction. Following the procedure for a systematic review this paper may contribute to a balanced evaluation of the need and effectiveness of IIPs. A pre-specified, registered protocol (CRD42012002150) was followed. Studies investigating all diabetes populations and types of IIPs were considered eligible. The sensitive search strategy was developed in collaboration with a clinical librarian and contents experts. PUBMED, MEDLINE, CENTRAL EMBASE, trial registries, and other databases were searched. References were screened independently by two authors, and decisions on study selection were recorded. Of the 1,703 references screened, 362 were assessed as potentially eligible. Ninety-four were identified as studies using IIPs. Fifteen papers, together reporting on four-randomized trials, and eight cohorts were included. Narrative analysis is provided, and data tables are available. CIPII by way of IIPs is effective in lowering HbA1c levels and reducing hypoglycaemic events. Superiority of IIP treatment is likely related to patient characteristics, one subgroup being patients unable to acquire satisfactory glycaemic control with subcutaneous insulin treatment. Higher treatment satisfaction was also reported for this subgroup. For these patients, risk of morbidity may be considered acceptable. Patients' perspectives, influence on quality of life, and possible other outcomes should also be considered important factors in weighing individual benefits and risks. A more uniform method of reporting would help strengthen the evidence base.

Intraperitoneal insulin delivery provides superior glycaemic regulation to subcutaneous insulin delivery in model predictive control‐based fully‐automated artificial pancreas in patients with type 1 diabetes: a pilot study

“…If sustained for 2 to 3 months in normal life, this improvement in glucose control with AP using IP insulin could result in lower HbA1c levels. Of note, even in open‐loop mode, IP insulin infusion from implantable insulin pumps has been reported as allowing lower HbA1c levels than CSII . IP infusion using the DiaPort system was not shown to reduce HbA1c levels significantly as compared with CSII, but occurrence of severe hypoglycaemia was dramatically reduced …”

Intraperitoneal insulin therapy for a patient with type 1 diabetes with insulin injection site inflammation

“…Efficacy in lowering HbA1c and acceptable morbidities with CIPII were also reported in a French 5-year retrospective review of 181 patients and in a recent systematic review 16 17. Two recent trials on the therapeutic effectiveness of CIPII have been conducted in the USA and the Netherlands; results are awaited 18 19.…”

Intraperitoneal insulin infusion: on the way to the artificial pancreas

“…В мета-анализе проведенных рандомизированных и когортных клинических исследований эффективно-сти и безопасности ИП-инфузии инсулина в сравнении с ПК [32] также был сделан вывод о наличии незначи-тельных, но достоверных преимуществ ИП-инфузии в отношении показателей гликемического контроля (рис. 6).…”

“…Клинические проспективные РКИ, сравнивающие непрерывную ПК-и ИП-инфузию инсулина при СД1 по НbA 1c и частоте гипогликемий [31] Показатели гликемического контроля при ИП-и ПК-инфузии инсулина, по данным мета-анализа [32] Исследование В портальной системе инсулин обнаруживается уже через 1 мин после ИП-введения [55]. У собак с уда-ленной поджелудочной железой ИП-инфузия инсулина оказывает такой же эффект на концентрацию глюкозы в периферическом кровотоке, как и при ВВ-инфузии [56].…”

“…ИП-инфузия обладает рядом преимуществ, крайне важ-ных для надежного длительного поддержания эуглике-мии с помощью ИПЖ [32]:…”