Complications of continuous intraperitoneal insulin infusion with an implantable pump
Open Access
- 1 January 2012
- journal article
- Published by Baishideng Publishing Group Inc. in World Journal of Diabetes
- Vol. 3 (8), 142-148
- https://doi.org/10.4239/wjd.v3.i8.142
Abstract
AIM: To monitor the course of continuous intraperitoneal insulin infusion (CIPII) and to gain more insight into possible complications. METHODS: A retrospective, longitudinal observational cohort study in patients with type 1 diabetes mellitus (T1DM) was performed. Only patients with “brittle” T1DM who started CIPII between January 1, 2000 and June 1, 2011, and were treated in the only centre in The Netherlands providing CIPII treatment (Isala clinics, Zwolle) were eligible for inclusion. Outcomes were defined as operation-free period (OFP), rate and type of complications. Subanalyses were made between patients starting CIPII from 2000 to 2007 and from 2007 onwards in order to study possible changes over time in complications and/or OFP. The OFP was calculated as the time from initial implantation to the date of first documented re-operation. If patients had not experienced an operation, their data were recorded at the date of last follow up or death. Kaplan-Meier curves were constructed to visualize the OFP. A (two-sided) P value of less than 0.05 was considered statistically significant. RESULTS: Fifty-seven patients were treated with CIPII, although one patient was excluded from analyses because of self-induced complications. In the remaining 56 patients, 70 complications occurred during 283 patient years. Catheter occlusion (32.9%), pump dysfunction (17.1%), pain at the pump site (15.7%) and infections (10.0%) were the most frequent complications. This resulted in a median OFP of 4.5 years (95% confidence interval 4.1-4.8 years) without any difference between the time periods. Fifty re-operations were performed because of complications, one per 5.6 patient years, with a decrease in pump dysfunction (P = 0.04) and pump explantations (P = 0.02) after 2007. In total, 9 episodes of ketoacidosis occurred during follow up and there were 69 hospital re-admissions, with a median duration of 6 d. CIPII was ceased in five patients due to recurrent infections (n = 2), pain (n = 1), inadequate glycaemic control (n = 1) or by own choice (n = 1). No CIPII related mortality was reported. CONCLUSION: The OFP has been stable over the last decade. No CIPII related mortality was reported. A significant decrease in pump dysfunction and explantation was seen after 2007 compared to the period 2000-2007. CIPII remains a safe treatment modality for specific patient groups.Keywords
This publication has 19 references indexed in Scilit:
- Implantable insulin pumps. A position statement about their clinical useDiabetes & Metabolism, 2007
- Clinical Evaluation of a Newly Designed Compliant Side Port Catheter for an Insulin Implantable PumpDiabetes Care, 2001
- Catheter Survival During Long-Term Insulin Therapy With an Implanted Programmable PumpDiabetes Care, 1997
- Insulin Underdelivery From Implanted Pumps Using Peritoneal Route: Determinant role of insulin pump compatibilityDiabetes Care, 1996
- Feasibility of Intraperitoneal Insulin Therapy With Programmable Implantable Pumps in IDDM: A multicenter studyDiabetes Care, 1995
- Catheter Complications Associated With Implantable Systems for Peritoneal Insulin Delivery: An analysis of frequency, predisposing factors, and obstructing materialsDiabetes Care, 1995
- French multicentre experience of implantable insulin pumpsThe Lancet, 1994
- Clinical Trial of Programmable Implantable Insulin Pump For Type I DiabetesDiabetes Care, 1992
- A Preliminary Trial of the Programmable Implantable Medication System for Insulin DeliveryNew England Journal of Medicine, 1989
- ONE-YEAR TRIAL OF A REMOTE-CONTROLLED IMPLANTABLE INSULIN INFUSION SYSTEM IN TYPE I DIABETIC PATIENTSThe Lancet, 1988