Summary:
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 SC 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).
Key words:
CSII - external pumps - implantable pumps - peritoneum
